home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-05 | 400.2 KB |
open in: 
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| df 0c 00 00 30 31 00 00 | 00 01 7b 12 00 00 3f 19 |....01..|..{...?.|
|00000030| 00 00 30 32 00 00 00 01 | ba 2b 00 00 3b 0c 00 00 |..02....|.+..;...|
|00000040| 30 33 00 00 00 01 f5 37 | 00 00 6d 0b 00 00 30 34 |03.....7|..m...04|
|00000050| 00 00 00 01 62 43 00 00 | 9e 0f 00 00 30 35 00 00 |....bC..|....05..|
|00000060| 00 01 00 53 00 00 59 0e | 00 00 30 36 00 00 00 01 |...S..Y.|..06....|
|00000070| 59 61 00 00 4d 0f 00 00 | 30 37 00 00 00 01 a6 70 |Ya..M...|07.....p|
|00000080| 00 00 a7 0a 00 00 30 38 | 00 00 00 01 4d 7b 00 00 |......08|....M{..|
|00000090| 4a 12 00 00 30 39 00 00 | 00 01 97 8d 00 00 15 0f |J...09..|........|
|000000a0| 00 00 31 30 00 00 00 01 | ac 9c 00 00 0e 10 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 ba ac | 00 00 24 13 00 00 31 32 |11......|..$...12|
|000000c0| 00 00 00 01 de bf 00 00 | a8 0d 00 00 31 33 00 00 |........|....13..|
|000000d0| 00 01 86 cd 00 00 72 14 | 00 00 31 34 00 00 00 01 |......r.|..14....|
|000000e0| f8 e1 00 00 34 0a 00 00 | 31 35 00 00 00 01 2c ec |....4...|15....,.|
|000000f0| 00 00 86 12 00 00 31 36 | 00 00 00 01 b2 fe 00 00 |......16|........|
|00000100| 28 12 00 00 31 37 00 00 | 00 01 da 10 01 00 ce 0f |(...17..|........|
|00000110| 00 00 31 38 00 00 00 01 | a8 20 01 00 5a 13 00 00 |..18....|. ..Z...|
|00000120| 31 39 00 00 00 01 02 34 | 01 00 05 12 00 00 32 30 |19.....4|......20|
|00000130| 00 00 00 01 07 46 01 00 | 64 12 00 00 32 31 00 00 |.....F..|d...21..|
|00000140| 00 01 6b 58 01 00 fc 11 | 00 00 32 32 00 00 00 01 |..kX....|..22....|
|00000150| 67 6a 01 00 74 0f 00 00 | 32 33 00 00 00 01 db 79 |gj..t...|23.....y|
|00000160| 01 00 5b 11 00 00 32 34 | 00 00 00 01 36 8b 01 00 |..[...24|....6...|
|00000170| c1 11 00 00 32 35 00 00 | 00 01 f7 9c 01 00 60 12 |....25..|......`.|
|00000180| 00 00 32 36 00 00 00 01 | 57 af 01 00 70 12 00 00 |..26....|W...p...|
|00000190| 32 37 00 00 00 01 c7 c1 | 01 00 4f 0f 00 00 32 38 |27......|..O...28|
|000001a0| 00 00 00 01 16 d1 01 00 | dd 0e 00 00 32 39 00 00 |........|....29..|
|000001b0| 00 01 f3 df 01 00 a4 10 | 00 00 33 30 00 00 00 01 |........|..30....|
|000001c0| 97 f0 01 00 b9 11 00 00 | 33 31 00 00 00 01 50 02 |........|31....P.|
|000001d0| 02 00 22 0c 00 00 33 32 | 00 00 00 01 72 0e 02 00 |.."...32|....r...|
|000001e0| cf 0c 00 00 33 33 00 00 | 00 01 41 1b 02 00 a3 0c |....33..|..A.....|
|000001f0| 00 00 33 34 00 00 00 01 | e4 27 02 00 94 15 00 00 |..34....|.'......|
|00000200| 33 35 00 00 00 01 78 3d | 02 00 89 12 00 00 33 36 |35....x=|......36|
|00000210| 00 00 00 01 01 50 02 00 | 59 0e 00 00 33 37 00 00 |.....P..|Y...37..|
|00000220| 00 01 5a 5e 02 00 95 12 | 00 00 33 38 00 00 00 01 |..Z^....|..38....|
|00000230| ef 70 02 00 72 0d 00 00 | 33 39 00 00 00 01 61 7e |.p..r...|39....a~|
|00000240| 02 00 b7 0d 00 00 34 30 | 00 00 00 01 18 8c 02 00 |......40|........|
|00000250| 42 0d 00 00 34 31 00 00 | 00 01 5a 99 02 00 5a 10 |B...41..|..Z...Z.|
|00000260| 00 00 34 32 00 00 00 01 | b4 a9 02 00 a4 0e 00 00 |..42....|........|
|00000270| 34 33 00 00 00 01 58 b8 | 02 00 a6 11 00 00 34 34 |43....X.|......44|
|00000280| 00 00 00 01 fe c9 02 00 | eb 14 00 00 34 35 00 00 |........|....45..|
|00000290| 00 01 e9 de 02 00 f3 0e | 00 00 34 36 00 00 00 01 |........|..46....|
|000002a0| dc ed 02 00 75 0c 00 00 | 34 37 00 00 00 01 51 fa |....u...|47....Q.|
|000002b0| 02 00 30 0d 00 00 34 38 | 00 00 00 01 81 07 03 00 |..0...48|........|
|000002c0| b5 10 00 00 34 39 00 00 | 00 01 36 18 03 00 07 0d |....49..|..6.....|
|000002d0| 00 00 35 30 00 00 00 01 | 3d 25 03 00 31 0e 00 00 |..50....|=%..1...|
|000002e0| 35 31 00 00 00 01 6e 33 | 03 00 bd 0f 00 00 35 32 |51....n3|......52|
|000002f0| 00 00 00 01 2b 43 03 00 | 20 10 00 00 35 33 00 00 |....+C..| ...53..|
|00000300| 00 01 4b 53 03 00 4a 13 | 00 00 35 34 00 00 00 01 |..KS..J.|..54....|
|00000310| 95 66 03 00 33 0d 00 00 | 35 35 00 00 00 01 c8 73 |.f..3...|55.....s|
|00000320| 03 00 cc 0c 00 00 35 36 | 00 00 00 01 94 80 03 00 |......56|........|
|00000330| 0d 16 00 00 35 37 00 00 | 00 01 a1 96 03 00 bd 11 |....57..|........|
|00000340| 00 00 35 38 00 00 00 01 | 5e a8 03 00 f9 0c 00 00 |..58....|^.......|
|00000350| 35 39 00 00 00 01 57 b5 | 03 00 11 0e 00 00 36 30 |59....W.|......60|
|00000360| 00 00 00 01 68 c3 03 00 | 1b 0f 00 00 36 31 00 00 |....h...|....61..|
|00000370| 00 01 83 d2 03 00 50 10 | 00 00 36 32 00 00 00 01 |......P.|..62....|
|00000380| d3 e2 03 00 71 0d 00 00 | 36 33 00 00 00 01 44 f0 |....q...|63....D.|
|00000390| 03 00 be 0e 00 00 36 34 | 00 00 00 01 02 ff 03 00 |......64|........|
|000003a0| f3 11 00 00 36 35 00 00 | 00 01 f5 10 04 00 b7 0d |....65..|........|
|000003b0| 00 00 36 36 00 00 00 01 | ac 1e 04 00 ea 0e 00 00 |..66....|........|
|000003c0| 36 37 00 00 00 01 96 2d | 04 00 3c 13 00 00 36 38 |67.....-|..<...68|
|000003d0| 00 00 00 01 d2 40 04 00 | 40 0d 00 00 36 39 00 00 |.....@..|@...69..|
|000003e0| 00 01 12 4e 04 00 ad 13 | 00 00 37 30 00 00 00 01 |...N....|..70....|
|000003f0| bf 61 04 00 fc 0e 00 00 | 37 31 00 00 00 01 bb 70 |.a......|71.....p|
|00000400| 04 00 dd 0d 00 00 37 32 | 00 00 00 01 98 7e 04 00 |......72|.....~..|
|00000410| fe 0e 00 00 37 33 00 00 | 00 01 96 8d 04 00 cc 0d |....73..|........|
|00000420| 00 00 37 34 00 00 00 01 | 62 9b 04 00 f5 0d 00 00 |..74....|b.......|
|00000430| 37 35 00 00 00 01 57 a9 | 04 00 a4 0f 00 00 37 36 |75....W.|......76|
|00000440| 00 00 00 01 fb b8 04 00 | 0b 0f 00 00 37 37 00 00 |........|....77..|
|00000450| 00 01 06 c8 04 00 fa 0f | 00 00 37 38 00 00 00 01 |........|..78....|
|00000460| 00 d8 04 00 5e 0d 00 00 | 37 39 00 00 00 01 5e e5 |....^...|79....^.|
|00000470| 04 00 41 0c 00 00 38 30 | 00 00 00 01 9f f1 04 00 |..A...80|........|
|00000480| ef 10 00 00 38 31 00 00 | 00 01 8e 02 05 00 e5 0e |....81..|........|
|00000490| 00 00 38 32 00 00 00 01 | 73 11 05 00 a3 10 00 00 |..82....|s.......|
|000004a0| 38 33 00 00 00 01 16 22 | 05 00 8c 10 00 00 38 34 |83....."|......84|
|000004b0| 00 00 00 01 a2 32 05 00 | 28 12 00 00 38 35 00 00 |.....2..|(...85..|
|000004c0| 00 01 ca 44 05 00 de 15 | 00 00 38 36 00 00 00 01 |...D....|..86....|
|000004d0| a8 5a 05 00 81 12 00 00 | 38 37 00 00 00 01 29 6d |.Z......|87....)m|
|000004e0| 05 00 91 10 00 00 38 38 | 00 00 00 01 ba 7d 05 00 |......88|.....}..|
|000004f0| 87 11 00 00 38 39 00 00 | 00 01 41 8f 05 00 56 14 |....89..|..A...V.|
|00000500| 00 00 39 30 00 00 00 01 | 97 a3 05 00 9a 13 00 00 |..90....|........|
|00000510| 39 31 00 00 00 01 31 b7 | 05 00 12 10 00 00 39 32 |91....1.|......92|
|00000520| 00 00 00 01 43 c7 05 00 | 00 11 00 00 39 33 00 00 |....C...|....93..|
|00000530| 00 01 43 d8 05 00 80 0d | 00 00 39 34 00 00 00 01 |..C.....|..94....|
|00000540| c3 e5 05 00 12 10 00 00 | 39 35 00 00 00 01 d5 f5 |........|95......|
|00000550| 05 00 5d 0f 00 00 39 36 | 00 00 00 01 32 05 06 00 |..]...96|....2...|
|00000560| 30 0e 00 00 39 37 00 00 | 00 01 62 13 06 00 ab 13 |0...97..|..b.....|
|00000570| 00 00 39 38 00 00 00 01 | 0d 27 06 00 a8 0a 00 00 |..98....|.'......|
|00000580| 39 39 00 00 00 01 b5 31 | 06 00 24 0f 00 00 00 00 |99.....1|..$.....|
|00000590| 00 00 00 00 d9 40 06 00 | 00 00 00 00 24 55 6e 69 |.....@..|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 32 34 30 30 7d |que_ID{Y|RB02400}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 45 66 66 65 63 74 20 |..$Title|{Effect |
|000005c0| 6f 66 20 4d 65 64 69 63 | 61 6c 20 61 6e 64 20 53 |of Medic|al and S|
|000005d0| 6f 63 69 61 6c 20 52 69 | 73 6b 20 46 61 63 74 6f |ocial Ri|sk Facto|
|000005e0| 72 73 20 6f 6e 20 4f 75 | 74 63 6f 6d 65 20 6f 66 |rs on Ou|tcome of|
|000005f0| 20 50 72 65 6d 61 74 75 | 72 69 74 79 20 61 6e 64 | Prematu|rity and|
|00000600| 0d 0a 56 65 72 79 20 4c | 6f 77 20 42 69 72 74 68 |..Very L|ow Birth|
|00000610| 20 57 65 69 67 68 74 7d | 0d 0a 24 41 75 74 68 6f | Weight}|..$Autho|
|00000620| 72 7b 0d 0a 4c 65 6f 6e | 61 72 64 2c 20 43 48 0d |r{..Leon|ard, CH.|
|00000630| 0a 43 6c 79 6d 61 6e 2c | 20 52 49 0d 0a 50 69 65 |.Clyman,| RI..Pie|
|00000640| 63 75 63 68 2c 20 52 45 | 0d 0a 4a 75 73 74 65 72 |cuch, RE|..Juster|
|00000650| 2c 20 4a 50 0d 0a 42 61 | 6c 6c 61 72 64 2c 20 52 |, JP..Ba|llard, R|
|00000660| 41 0d 0a 42 65 68 6c 65 | 2c 20 4d 42 7d 0d 0a 24 |A..Behle|, MB}..$|
|00000670| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 4d 6f 75 6e |Affiliat|ion{Moun|
|00000680| 74 20 5a 69 6f 6e 20 48 | 6f 73 70 20 61 6e 64 20 |t Zion H|osp and |
|00000690| 4d 65 64 20 43 74 72 2c | 20 53 61 6e 20 46 72 61 |Med Ctr,| San Fra|
|000006a0| 6e 63 69 73 63 6f 7d 0d | 0a 24 4a 6f 75 72 6e 61 |ncisco}.|.$Journa|
|000006b0| 6c 7b 4a 20 50 65 64 69 | 61 74 72 7d 0d 0a 24 56 |l{J Pedi|atr}..$V|
|000006c0| 6f 6c 75 6d 65 7b 31 31 | 36 7d 0d 0a 24 50 61 67 |olume{11|6}..$Pag|
|000006d0| 65 7b 36 32 30 2d 36 32 | 36 7d 0d 0a 24 44 61 74 |e{620-62|6}..$Dat|
|000006e0| 65 7b 31 39 39 30 7d 0d | 0a 24 59 42 56 6f 6c 7b |e{1990}.|.$YBVol{|
|000006f0| 31 39 39 31 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1991 Yea|r Book o|
|00000700| 66 20 4e 65 6f 6e 61 74 | 61 6c 20 61 6e 64 20 50 |f Neonat|al and P|
|00000710| 65 72 69 6e 61 74 61 6c | 20 4d 65 64 69 63 69 6e |erinatal| Medicin|
|00000720| 65 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 31 37 2d |e}..$Cha|pter{17-|
|00000730| 31 31 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |11}..$YB|Editor{D|
|00000740| 72 73 2e 20 4b 6c 61 75 | 73 20 61 6e 64 20 46 61 |rs. Klau|s and Fa|
|00000750| 6e 61 72 6f 66 66 7d 0d | 0a 24 54 61 62 6c 65 7b |naroff}.|.$Table{|
|00000760| 54 61 62 6c 65 20 4f 6d | 69 74 74 65 64 7d 0d 0a |Table Om|itted}..|
|00000770| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 4d 2e 48 |$Comment|ator{M.H|
|00000780| 2e 20 4b 6c 61 75 73 2c | 20 4d 2e 44 2e 7d 0d 0a |. Klaus,| M.D.}..|
|00000790| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 43 29 20 |..Copyri|ght (C) |
|000007a0| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|000007b0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|000007c0| 63 2e 20 31 39 39 31 0d | 0a 0d 0a 31 39 39 31 20 |c. 1991.|...1991 |
|000007d0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4e 65 6f |Year Boo|k of Neo|
|000007e0| 6e 61 74 61 6c 20 61 6e | 64 20 50 65 72 69 6e 61 |natal an|d Perina|
|000007f0| 74 61 6c 20 4d 65 64 69 | 63 69 6e 65 0d 0a 0d 0a |tal Medi|cine....|
|00000800| 43 68 61 70 74 65 72 20 | 31 37 20 2d 2d 20 4f 75 |Chapter |17 -- Ou|
|00000810| 74 63 6f 6d 65 20 2d 2d | 20 50 6f 73 74 6e 61 74 |tcome --| Postnat|
|00000820| 61 6c 20 47 72 6f 77 74 | 68 20 61 6e 64 20 44 65 |al Growt|h and De|
|00000830| 76 65 6c 6f 70 6d 65 6e | 74 0d 0a 0d 0a 2d 2d 2d |velopmen|t....---|
|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 45 66 66 |--------|---..Eff|
|00000890| 65 63 74 20 6f 66 20 4d | 65 64 69 63 61 6c 20 61 |ect of M|edical a|
|000008a0| 6e 64 20 53 6f 63 69 61 | 6c 20 52 69 73 6b 20 46 |nd Socia|l Risk F|
|000008b0| 61 63 74 6f 72 73 20 6f | 6e 20 4f 75 74 63 6f 6d |actors o|n Outcom|
|000008c0| 65 20 6f 66 20 50 72 65 | 6d 61 74 75 72 69 74 79 |e of Pre|maturity|
|000008d0| 20 61 6e 64 20 56 65 72 | 79 0d 0a 4c 6f 77 20 42 | and Ver|y..Low B|
|000008e0| 69 72 74 68 20 57 65 69 | 67 68 74 0d 0a 0d 0a 4c |irth Wei|ght....L|
|000008f0| 65 6f 6e 61 72 64 20 43 | 48 3b 20 43 6c 79 6d 61 |eonard C|H; Clyma|
|00000900| 6e 20 52 49 3b 20 50 69 | 65 63 75 63 68 20 52 45 |n RI; Pi|ecuch RE|
|00000910| 3b 20 4a 75 73 74 65 72 | 20 4a 50 3b 20 42 61 6c |; Juster| JP; Bal|
|00000920| 6c 61 72 64 20 52 41 3b | 20 42 65 68 6c 65 20 4d |lard RA;| Behle M|
|00000930| 42 0d 0a 28 4d 6f 75 6e | 74 20 5a 69 6f 6e 20 48 |B..(Moun|t Zion H|
|00000940| 6f 73 70 20 61 6e 64 20 | 4d 65 64 20 43 74 72 2c |osp and |Med Ctr,|
|00000950| 20 53 61 6e 20 46 72 61 | 6e 63 69 73 63 6f 29 0d | San Fra|ncisco).|
|00000960| 0a 4a 20 50 65 64 69 61 | 74 72 20 31 31 36 3a 36 |.J Pedia|tr 116:6|
|00000970| 32 30 2d 36 32 36 2c 20 | 31 39 39 30 0d 0a 2d 2d |20-626, |1990..--|
|00000980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|000009d0| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|000009e0| 20 49 6e 20 61 64 64 69 | 74 69 6f 6e 20 74 6f 20 | In addi|tion to |
|000009f0| 61 20 68 69 67 68 20 6d | 65 64 69 63 61 6c 20 72 |a high m|edical r|
|00000a00| 69 73 6b 2c 20 76 65 72 | 79 2d 6c 6f 77 2d 62 69 |isk, ver|y-low-bi|
|00000a10| 72 74 68 2d 77 65 69 67 | 68 74 20 69 6e 66 61 6e |rth-weig|ht infan|
|00000a20| 74 73 20 6d 61 79 0d 0a | 68 61 76 65 20 69 6e 63 |ts may..|have inc|
|00000a30| 72 65 61 73 65 64 20 76 | 75 6c 6e 65 72 61 62 69 |reased v|ulnerabi|
|00000a40| 6c 69 74 79 20 74 6f 20 | 65 6e 76 69 72 6f 6e 6d |lity to |environm|
|00000a50| 65 6e 74 61 6c 20 73 74 | 72 65 73 73 65 73 2e 20 |ental st|resses. |
|00000a60| 20 49 74 20 77 61 73 20 | 68 79 70 6f 74 68 65 73 | It was |hypothes|
|00000a70| 69 7a 65 64 0d 0a 74 68 | 61 74 20 73 6f 6d 65 20 |ized..th|at some |
|00000a80| 61 73 70 65 63 74 73 20 | 6f 66 20 70 61 72 65 6e |aspects |of paren|
|00000a90| 74 69 6e 67 20 6d 61 79 | 20 61 66 66 65 63 74 20 |ting may| affect |
|00000aa0| 74 68 65 20 63 6f 67 6e | 69 74 69 76 65 20 6f 75 |the cogn|itive ou|
|00000ab0| 74 63 6f 6d 65 20 6f 66 | 20 74 68 65 73 65 0d 0a |tcome of| these..|
|00000ac0| 69 6e 66 61 6e 74 73 2e | 20 20 49 6e 20 61 20 70 |infants.| In a p|
|00000ad0| 72 6f 73 70 65 63 74 69 | 76 65 20 73 74 75 64 79 |rospecti|ve study|
|00000ae0| 2c 20 31 32 39 20 6f 66 | 20 33 32 36 20 69 6e 66 |, 129 of| 326 inf|
|00000af0| 61 6e 74 73 20 77 69 74 | 68 20 62 69 72 74 68 20 |ants wit|h birth |
|00000b00| 77 65 69 67 68 74 73 20 | 6f 66 0d 0a 31 2c 32 35 |weights |of..1,25|
|00000b10| 30 20 67 20 6f 72 20 6c | 65 73 73 20 77 65 72 65 |0 g or l|ess were|
|00000b20| 20 66 6f 6c 6c 6f 77 65 | 64 20 66 6f 72 20 6d 6f | followe|d for mo|
|00000b30| 72 65 20 74 68 61 6e 20 | 34 20 31 2f 32 20 79 65 |re than |4 1/2 ye|
|00000b40| 61 72 73 20 28 6d 65 61 | 6e 2c 20 36 30 20 6d 6f |ars (mea|n, 60 mo|
|00000b50| 6e 74 68 73 29 20 74 6f | 0d 0a 64 65 74 65 72 6d |nths) to|..determ|
|00000b60| 69 6e 65 20 74 68 65 20 | 69 6e 64 65 70 65 6e 64 |ine the |independ|
|00000b70| 65 6e 74 20 65 66 66 65 | 63 74 73 20 6f 66 20 32 |ent effe|cts of 2|
|00000b80| 20 6d 65 64 69 63 61 6c | 20 72 69 73 6b 20 66 61 | medical| risk fa|
|00000b90| 63 74 6f 72 73 2c 20 69 | 6e 74 72 61 63 72 61 6e |ctors, i|ntracran|
|00000ba0| 69 61 6c 0d 0a 68 65 6d | 6f 72 72 68 61 67 65 20 |ial..hem|orrhage |
|00000bb0| 28 49 43 48 29 20 61 6e | 64 20 73 65 76 65 72 65 |(ICH) an|d severe|
|00000bc0| 20 63 68 72 6f 6e 69 63 | 20 6c 75 6e 67 20 64 69 | chronic| lung di|
|00000bd0| 73 65 61 73 65 20 28 43 | 4c 44 29 2c 20 61 6e 64 |sease (C|LD), and|
|00000be0| 20 61 20 70 61 72 65 6e | 74 69 6e 67 20 72 69 73 | a paren|ting ris|
|00000bf0| 6b 0d 0a 66 61 63 74 6f | 72 2c 20 65 69 74 68 65 |k..facto|r, eithe|
|00000c00| 72 20 61 62 75 73 65 20 | 6f 72 20 6e 65 67 6c 65 |r abuse |or negle|
|00000c10| 63 74 2c 20 6f 6e 20 6e | 65 75 72 6f 64 65 76 65 |ct, on n|eurodeve|
|00000c20| 6c 6f 70 6d 65 6e 74 61 | 6c 20 6f 75 74 63 6f 6d |lopmenta|l outcom|
|00000c30| 65 2e 0d 0a 20 20 20 20 | 20 53 65 76 65 72 65 20 |e... | Severe |
|00000c40| 43 4c 44 20 69 6e 20 69 | 6e 66 61 6e 74 73 20 77 |CLD in i|nfants w|
|00000c50| 69 74 68 6f 75 74 20 49 | 43 48 20 61 6e 64 20 61 |ithout I|CH and a|
|00000c60| 20 70 61 72 65 6e 74 69 | 6e 67 20 72 69 73 6b 20 | parenti|ng risk |
|00000c70| 66 61 63 74 6f 72 20 77 | 61 73 20 6e 6f 74 0d 0a |factor w|as not..|
|00000c80| 72 65 6c 61 74 65 64 20 | 74 6f 20 74 68 65 20 6e |related |to the n|
|00000c90| 65 75 72 6f 6c 6f 67 69 | 63 20 6f 72 20 63 6f 67 |eurologi|c or cog|
|00000ca0| 6e 69 74 69 76 65 20 6f | 75 74 63 6f 6d 65 2e 20 |nitive o|utcome. |
|00000cb0| 20 49 6e 20 63 6f 6e 74 | 72 61 73 74 2c 20 69 6e | In cont|rast, in|
|00000cc0| 63 72 65 61 73 69 6e 67 | 0d 0a 67 72 61 64 65 73 |creasing|..grades|
|00000cd0| 20 6f 66 20 49 43 48 20 | 63 6f 72 72 65 6c 61 74 | of ICH |correlat|
|00000ce0| 65 64 20 70 6f 73 69 74 | 69 76 65 6c 79 20 77 69 |ed posit|ively wi|
|00000cf0| 74 68 20 61 6e 20 69 6e | 63 72 65 61 73 69 6e 67 |th an in|creasing|
|00000d00| 20 72 61 74 65 20 6f 66 | 20 6e 65 75 72 6f 6c 6f | rate of| neurolo|
|00000d10| 67 69 63 20 61 6e 64 0d | 0a 63 6f 67 6e 69 74 69 |gic and.|.cogniti|
|00000d20| 76 65 20 64 65 66 69 63 | 69 74 73 2e 20 20 50 61 |ve defic|its. Pa|
|00000d30| 72 65 6e 74 69 6e 67 20 | 72 69 73 6b 20 69 6e 20 |renting |risk in |
|00000d40| 63 68 69 6c 64 72 65 6e | 20 77 69 74 68 20 6e 6f |children| with no|
|00000d50| 20 49 43 48 20 77 61 73 | 20 6e 6f 74 20 61 73 73 | ICH was| not ass|
|00000d60| 6f 63 69 61 74 65 64 0d | 0a 77 69 74 68 20 61 62 |ociated.|.with ab|
|00000d70| 6e 6f 72 6d 61 6c 20 6e | 65 75 72 6f 6c 6f 67 69 |normal n|eurologi|
|00000d80| 63 20 6f 75 74 63 6f 6d | 65 20 62 75 74 20 77 61 |c outcom|e but wa|
|00000d90| 73 20 73 74 72 6f 6e 67 | 6c 79 20 61 73 73 6f 63 |s strong|ly assoc|
|00000da0| 69 61 74 65 64 20 77 69 | 74 68 20 61 62 6e 6f 72 |iated wi|th abnor|
|00000db0| 6d 61 6c 0d 0a 63 6f 67 | 6e 69 74 69 76 65 20 6f |mal..cog|nitive o|
|00000dc0| 75 74 63 6f 6d 65 2e 20 | 20 4c 6f 77 20 73 6f 63 |utcome. | Low soc|
|00000dd0| 69 6f 65 63 6f 6e 6f 6d | 69 63 20 73 74 61 74 75 |ioeconom|ic statu|
|00000de0| 73 20 28 53 45 53 29 20 | 64 69 64 20 6e 6f 74 20 |s (SES) |did not |
|00000df0| 65 78 70 6c 61 69 6e 20 | 74 68 65 0d 0a 63 6f 67 |explain |the..cog|
|00000e00| 6e 69 74 69 76 65 20 64 | 65 66 69 63 69 74 73 20 |nitive d|eficits |
|00000e10| 69 6e 20 63 68 69 6c 64 | 72 65 6e 20 77 69 74 68 |in child|ren with|
|00000e20| 20 61 20 70 61 72 65 6e | 74 69 6e 67 20 72 69 73 | a paren|ting ris|
|00000e30| 6b 2e 20 20 4c 69 6e 65 | 61 72 20 6c 6f 67 69 73 |k. Line|ar logis|
|00000e40| 74 69 63 0d 0a 72 65 67 | 72 65 73 73 69 6f 6e 20 |tic..reg|ression |
|00000e50| 61 6e 61 6c 79 73 69 73 | 20 73 68 6f 77 65 64 20 |analysis| showed |
|00000e60| 74 68 61 74 20 74 68 65 | 20 70 61 72 65 6e 74 69 |that the| parenti|
|00000e70| 6e 67 20 72 69 73 6b 20 | 66 61 63 74 6f 72 20 77 |ng risk |factor w|
|00000e80| 61 73 20 61 73 73 6f 63 | 69 61 74 65 64 20 77 69 |as assoc|iated wi|
|00000e90| 74 68 0d 0a 74 68 65 20 | 68 69 67 68 65 73 74 20 |th..the |highest |
|00000ea0| 72 69 73 6b 20 6f 66 20 | 6c 61 74 65 72 20 61 62 |risk of |later ab|
|00000eb0| 6e 6f 72 6d 61 6c 69 74 | 79 20 28 46 69 67 20 31 |normalit|y (Fig 1|
|00000ec0| 37 2d 31 29 2e 0d 0a 20 | 20 20 20 20 54 68 65 73 |7-1)... | Thes|
|00000ed0| 65 20 66 69 6e 64 69 6e | 67 73 20 69 6e 64 69 63 |e findin|gs indic|
|00000ee0| 61 74 65 20 74 68 61 74 | 20 69 6e 66 61 6e 74 73 |ate that| infants|
|00000ef0| 20 77 69 74 68 20 6d 65 | 64 69 63 61 6c 20 72 69 | with me|dical ri|
|00000f00| 73 6b 20 66 61 63 74 6f | 72 73 20 6d 61 79 20 68 |sk facto|rs may h|
|00000f10| 61 76 65 0d 0a 61 64 64 | 69 74 69 6f 6e 61 6c 20 |ave..add|itional |
|00000f20| 73 6f 63 69 61 6c 20 72 | 69 73 6b 20 66 61 63 74 |social r|isk fact|
|00000f30| 6f 72 73 2e 20 20 54 68 | 65 73 65 20 69 6e 66 61 |ors. Th|ese infa|
|00000f40| 6e 74 73 20 6d 61 79 20 | 68 61 76 65 20 68 65 69 |nts may |have hei|
|00000f50| 67 68 74 65 6e 65 64 20 | 73 65 6e 73 69 74 69 76 |ghtened |sensitiv|
|00000f60| 69 74 79 0d 0a 74 6f 20 | 61 20 73 75 62 6f 70 74 |ity..to |a subopt|
|00000f70| 69 6d 61 6c 20 66 61 6d | 69 6c 79 20 65 6e 76 69 |imal fam|ily envi|
|00000f80| 72 6f 6e 6d 65 6e 74 2e | 20 20 42 6f 74 68 20 6d |ronment.| Both m|
|00000f90| 65 64 69 63 61 6c 20 61 | 6e 64 20 73 6f 63 69 61 |edical a|nd socia|
|00000fa0| 6c 20 72 69 73 6b 20 66 | 61 63 74 6f 72 73 0d 0a |l risk f|actors..|
|00000fb0| 73 68 6f 75 6c 64 20 62 | 65 20 63 6f 6e 73 69 64 |should b|e consid|
|00000fc0| 65 72 65 64 20 69 6e 20 | 74 68 65 20 61 73 73 65 |ered in |the asse|
|00000fd0| 73 73 6d 65 6e 74 20 6f | 66 20 6c 6f 6e 67 2d 74 |ssment o|f long-t|
|00000fe0| 65 72 6d 20 73 65 71 75 | 65 6c 61 65 20 6f 66 20 |erm sequ|elae of |
|00000ff0| 6e 65 6f 6e 61 74 61 6c | 0d 0a 63 6f 6d 70 6c 69 |neonatal|..compli|
|00001000| 63 61 74 69 6f 6e 73 2e | 0d 0a 0d 0a 50 6f 73 74 |cations.|....Post|
|00001010| 2d 43 6f 6d 6d 65 6e 74 | 0d 0a 0d 0a 20 20 20 20 |-Comment|.... |
|00001020| 20 49 6e 20 74 68 65 20 | 70 61 73 74 2c 20 74 68 | In the |past, th|
|00001030| 65 20 63 6f 67 6e 69 74 | 69 76 65 20 64 65 76 65 |e cognit|ive deve|
|00001040| 6c 6f 70 6d 65 6e 74 20 | 6f 66 20 74 68 65 20 73 |lopment |of the s|
|00001050| 6d 61 6c 6c 20 69 6d 6d | 61 74 75 72 65 20 69 6e |mall imm|ature in|
|00001060| 66 61 6e 74 0d 0a 61 70 | 70 65 61 72 65 64 20 74 |fant..ap|peared t|
|00001070| 6f 20 62 65 20 63 6c 6f | 73 65 6c 79 20 63 6f 72 |o be clo|sely cor|
|00001080| 72 65 6c 61 74 65 64 20 | 74 6f 20 74 68 65 20 53 |related |to the S|
|00001090| 45 53 20 6f 66 20 74 68 | 65 20 66 61 6d 69 6c 79 |ES of th|e family|
|000010a0| 20 28 31 29 2e 20 20 57 | 68 61 74 20 69 73 20 6d | (1). W|hat is m|
|000010b0| 6f 73 74 0d 0a 64 69 73 | 63 6f 6e 63 65 72 74 69 |ost..dis|concerti|
|000010c0| 6e 67 20 69 73 20 74 68 | 61 74 20 74 68 65 20 70 |ng is th|at the p|
|000010d0| 61 72 65 6e 74 69 6e 67 | 20 72 69 73 6b 20 66 61 |arenting| risk fa|
|000010e0| 63 74 6f 72 20 68 61 64 | 20 61 6e 20 65 76 65 6e |ctor had| an even|
|000010f0| 20 67 72 65 61 74 65 72 | 20 65 66 66 65 63 74 20 | greater| effect |
|00001100| 6f 6e 0d 0a 63 6f 67 6e | 69 74 69 76 65 20 64 65 |on..cogn|itive de|
|00001110| 76 65 6c 6f 70 6d 65 6e | 74 20 74 68 61 6e 20 53 |velopmen|t than S|
|00001120| 45 53 20 6f 72 20 69 6e | 74 72 61 76 65 6e 74 72 |ES or in|traventr|
|00001130| 69 63 75 6c 61 72 20 68 | 65 6d 6f 72 72 68 61 67 |icular h|emorrhag|
|00001140| 65 2e 20 20 41 20 73 69 | 67 6e 69 66 69 63 61 6e |e. A si|gnifican|
|00001150| 74 0d 0a 70 61 72 65 6e | 74 69 6e 67 20 72 69 73 |t..paren|ting ris|
|00001160| 6b 20 66 61 63 74 6f 72 | 20 77 61 73 20 64 65 66 |k factor| was def|
|00001170| 69 6e 65 64 20 61 73 20 | 61 20 72 65 66 65 72 72 |ined as |a referr|
|00001180| 61 6c 20 62 79 20 61 20 | 70 68 79 73 69 63 69 61 |al by a |physicia|
|00001190| 6e 2c 20 6e 75 72 73 65 | 2c 20 6f 72 0d 0a 61 66 |n, nurse|, or..af|
|000011a0| 66 69 6c 69 61 74 65 64 | 20 68 65 61 6c 74 68 20 |filiated| health |
|000011b0| 70 72 6f 66 65 73 73 69 | 6f 6e 61 6c 20 74 6f 20 |professi|onal to |
|000011c0| 70 72 6f 74 65 63 74 69 | 76 65 20 73 65 72 76 69 |protecti|ve servi|
|000011d0| 63 65 73 20 66 6f 72 20 | 6e 65 67 6c 65 63 74 20 |ces for |neglect |
|000011e0| 6f 72 20 6d 69 6c 64 0d | 0a 61 62 75 73 65 2e 20 |or mild.|.abuse. |
|000011f0| 20 49 6e 20 74 68 65 20 | 66 75 74 75 72 65 2c 20 | In the |future, |
|00001200| 61 20 6d 6f 72 65 20 64 | 65 74 61 69 6c 65 64 20 |a more d|etailed |
|00001210| 73 74 75 64 79 20 6f 66 | 20 74 68 65 20 70 61 72 |study of| the par|
|00001220| 65 6e 74 73 20 73 68 6f | 75 6c 64 20 62 65 20 6d |ents sho|uld be m|
|00001230| 61 64 65 0d 0a 62 65 66 | 6f 72 65 20 74 68 65 20 |ade..bef|ore the |
|00001240| 69 6e 66 61 6e 74 20 69 | 73 20 64 69 73 63 68 61 |infant i|s discha|
|00001250| 72 67 65 64 20 66 72 6f | 6d 20 74 68 65 20 68 6f |rged fro|m the ho|
|00001260| 73 70 69 74 61 6c 2e 2d | 2d 4d 2e 48 2e 20 4b 6c |spital.-|-M.H. Kl|
|00001270| 61 75 73 2c 20 4d 2e 44 | 2e 0d 0a 24 55 6e 69 71 |aus, M.D|...$Uniq|
|00001280| 75 65 5f 49 44 7b 59 52 | 42 30 32 34 30 31 7d 0d |ue_ID{YR|B02401}.|
|00001290| 0a 24 54 69 74 6c 65 7b | 45 61 72 6c 79 20 44 69 |.$Title{|Early Di|
|000012a0| 65 74 20 69 6e 20 50 72 | 65 74 65 72 6d 20 42 61 |et in Pr|eterm Ba|
|000012b0| 62 69 65 73 20 61 6e 64 | 20 44 65 76 65 6c 6f 70 |bies and| Develop|
|000012c0| 6d 65 6e 74 61 6c 20 53 | 74 61 74 75 73 20 61 74 |mental S|tatus at|
|000012d0| 20 31 38 20 4d 6f 6e 74 | 68 73 7d 0d 0a 24 41 75 | 18 Mont|hs}..$Au|
|000012e0| 74 68 6f 72 7b 0d 0a 4c | 75 63 61 73 2c 20 41 0d |thor{..L|ucas, A.|
|000012f0| 0a 4d 6f 72 6c 65 79 2c | 20 52 0d 0a 43 6f 6c 65 |.Morley,| R..Cole|
|00001300| 2c 20 54 4a 0d 0a 47 6f | 72 65 2c 20 53 4d 0d 0a |, TJ..Go|re, SM..|
|00001310| 4c 75 63 61 73 2c 20 50 | 4a 0d 0a 43 72 6f 77 6c |Lucas, P|J..Crowl|
|00001320| 65 79 2c 20 50 0d 0a 50 | 65 61 72 73 65 2c 20 52 |ey, P..P|earse, R|
|00001330| 0d 0a 42 6f 6f 6e 2c 20 | 41 4a 0d 0a 50 6f 77 65 |..Boon, |AJ..Powe|
|00001340| 6c 6c 2c 20 52 7d 0d 0a | 24 41 66 66 69 6c 69 61 |ll, R}..|$Affilia|
|00001350| 74 69 6f 6e 7b 4d 65 64 | 20 52 65 73 65 61 72 63 |tion{Med| Researc|
|00001360| 68 20 43 6f 75 6e 63 69 | 6c 20 44 75 6e 6e 20 4e |h Counci|l Dunn N|
|00001370| 75 74 72 69 74 69 6f 6e | 61 6c 20 55 6e 69 74 2c |utrition|al Unit,|
|00001380| 20 43 61 6d 62 72 69 64 | 67 65 3b 20 4d 52 43 0d | Cambrid|ge; MRC.|
|00001390| 0a 42 69 6f 73 74 61 74 | 69 73 74 69 63 73 20 55 |.Biostat|istics U|
|000013a0| 6e 69 74 2c 20 43 61 6d | 62 72 69 64 67 65 3b 20 |nit, Cam|bridge; |
|000013b0| 4e 6f 72 66 6f 6c 6b 20 | 61 6e 64 20 4e 6f 72 77 |Norfolk |and Norw|
|000013c0| 69 63 68 20 48 6f 73 70 | 2c 20 4e 6f 72 77 69 63 |ich Hosp|, Norwic|
|000013d0| 68 3b 20 4a 65 73 73 6f | 70 20 48 6f 73 70 2c 0d |h; Jesso|p Hosp,.|
|000013e0| 0a 53 68 65 66 66 69 65 | 6c 64 2c 20 45 6e 67 6c |.Sheffie|ld, Engl|
|000013f0| 61 6e 64 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 4c |and}..$J|ournal{L|
|00001400| 61 6e 63 65 74 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |ancet}..|$Volume{|
|00001410| 33 33 35 7d 0d 0a 24 50 | 61 67 65 7b 31 34 37 37 |335}..$P|age{1477|
|00001420| 2d 31 34 38 31 7d 0d 0a | 24 44 61 74 65 7b 31 39 |-1481}..|$Date{19|
|00001430| 39 30 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 31 |90}..$YB|Vol{1991|
|00001440| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4e 65 | Year Bo|ok of Ne|
|00001450| 6f 6e 61 74 61 6c 20 61 | 6e 64 20 50 65 72 69 6e |onatal a|nd Perin|
|00001460| 61 74 61 6c 20 4d 65 64 | 69 63 69 6e 65 7d 0d 0a |atal Med|icine}..|
|00001470| 24 43 68 61 70 74 65 72 | 7b 31 37 2d 31 32 7d 0d |$Chapter|{17-12}.|
|00001480| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00001490| 4b 6c 61 75 73 20 61 6e | 64 20 46 61 6e 61 72 6f |Klaus an|d Fanaro|
|000014a0| 66 66 7d 0d 0a 24 54 61 | 62 6c 65 7b 54 61 62 6c |ff}..$Ta|ble{Tabl|
|000014b0| 65 20 4f 6d 69 74 74 65 | 64 7d 0d 0a 24 43 6f 6d |e Omitte|d}..$Com|
|000014c0| 6d 65 6e 74 61 74 6f 72 | 7b 52 2e 20 55 6d 61 6e |mentator|{R. Uman|
|000014d0| 73 6b 79 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |sky, M.D|.}....Co|
|000014e0| 70 79 72 69 67 68 74 20 | 28 43 29 20 59 65 61 72 |pyright |(C) Year|
|000014f0| 20 42 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 | Book Me|dical Pu|
|00001500| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 20 31 |blishers|, Inc. 1|
|00001510| 39 39 31 0d 0a 0d 0a 31 | 39 39 31 20 59 65 61 72 |991....1|991 Year|
|00001520| 20 42 6f 6f 6b 20 6f 66 | 20 4e 65 6f 6e 61 74 61 | Book of| Neonata|
|00001530| 6c 20 61 6e 64 20 50 65 | 72 69 6e 61 74 61 6c 20 |l and Pe|rinatal |
|00001540| 4d 65 64 69 63 69 6e 65 | 0d 0a 0d 0a 43 68 61 70 |Medicine|....Chap|
|00001550| 74 65 72 20 31 37 20 2d | 2d 20 4f 75 74 63 6f 6d |ter 17 -|- Outcom|
|00001560| 65 20 2d 2d 20 50 6f 73 | 74 6e 61 74 61 6c 20 47 |e -- Pos|tnatal G|
|00001570| 72 6f 77 74 68 20 61 6e | 64 20 44 65 76 65 6c 6f |rowth an|d Develo|
|00001580| 70 6d 65 6e 74 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |pment...|.-------|
|00001590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000015a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000015b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000015c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000015d0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 45 61 72 6c 79 20 44 |-------.|.Early D|
|000015e0| 69 65 74 20 69 6e 20 50 | 72 65 74 65 72 6d 20 42 |iet in P|reterm B|
|000015f0| 61 62 69 65 73 20 61 6e | 64 20 44 65 76 65 6c 6f |abies an|d Develo|
|00001600| 70 6d 65 6e 74 61 6c 20 | 53 74 61 74 75 73 20 61 |pmental |Status a|
|00001610| 74 20 31 38 20 4d 6f 6e | 74 68 73 0d 0a 0d 0a 4c |t 18 Mon|ths....L|
|00001620| 75 63 61 73 20 41 3b 20 | 4d 6f 72 6c 65 79 20 52 |ucas A; |Morley R|
|00001630| 3b 20 43 6f 6c 65 20 54 | 4a 3b 20 47 6f 72 65 20 |; Cole T|J; Gore |
|00001640| 53 4d 3b 20 4c 75 63 61 | 73 20 50 4a 3b 20 43 72 |SM; Luca|s PJ; Cr|
|00001650| 6f 77 6c 65 79 20 50 3b | 20 50 65 61 72 73 65 20 |owley P;| Pearse |
|00001660| 52 3b 20 42 6f 6f 6e 20 | 41 4a 3b 0d 0a 50 6f 77 |R; Boon |AJ;..Pow|
|00001670| 65 6c 6c 20 52 0d 0a 28 | 4d 65 64 20 52 65 73 65 |ell R..(|Med Rese|
|00001680| 61 72 63 68 20 43 6f 75 | 6e 63 69 6c 20 44 75 6e |arch Cou|ncil Dun|
|00001690| 6e 20 4e 75 74 72 69 74 | 69 6f 6e 61 6c 20 55 6e |n Nutrit|ional Un|
|000016a0| 69 74 2c 20 43 61 6d 62 | 72 69 64 67 65 3b 20 4d |it, Camb|ridge; M|
|000016b0| 52 43 20 42 69 6f 73 74 | 61 74 69 73 74 69 63 73 |RC Biost|atistics|
|000016c0| 0d 0a 55 6e 69 74 2c 20 | 43 61 6d 62 72 69 64 67 |..Unit, |Cambridg|
|000016d0| 65 3b 20 4e 6f 72 66 6f | 6c 6b 20 61 6e 64 20 4e |e; Norfo|lk and N|
|000016e0| 6f 72 77 69 63 68 20 48 | 6f 73 70 2c 20 4e 6f 72 |orwich H|osp, Nor|
|000016f0| 77 69 63 68 3b 20 4a 65 | 73 73 6f 70 20 48 6f 73 |wich; Je|ssop Hos|
|00001700| 70 2c 20 53 68 65 66 66 | 69 65 6c 64 2c 0d 0a 45 |p, Sheff|ield,..E|
|00001710| 6e 67 6c 61 6e 64 29 0d | 0a 4c 61 6e 63 65 74 20 |ngland).|.Lancet |
|00001720| 33 33 35 3a 31 34 37 37 | 2d 31 34 38 31 2c 20 31 |335:1477|-1481, 1|
|00001730| 39 39 30 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |990..---|--------|
|00001740| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001780| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00001790| 0a 0d 0a 20 20 20 20 20 | 57 68 65 74 68 65 72 20 |... |Whether |
|000017a0| 6e 75 74 72 69 74 69 6f | 6e 20 69 6e 20 65 61 72 |nutritio|n in ear|
|000017b0| 6c 79 20 6c 69 66 65 20 | 68 61 73 20 61 20 6c 6f |ly life |has a lo|
|000017c0| 6e 67 2d 74 65 72 6d 20 | 69 6d 70 61 63 74 20 6f |ng-term |impact o|
|000017d0| 6e 0d 0a 6e 65 75 72 6f | 64 65 76 65 6c 6f 70 6d |n..neuro|developm|
|000017e0| 65 6e 74 61 6c 20 6f 75 | 74 63 6f 6d 65 20 72 65 |ental ou|tcome re|
|000017f0| 6d 61 69 6e 73 20 63 6f | 6e 74 72 6f 76 65 72 73 |mains co|ntrovers|
|00001800| 69 61 6c 2e 20 20 54 77 | 6f 20 70 61 72 61 6c 6c |ial. Tw|o parall|
|00001810| 65 6c 20 73 74 75 64 69 | 65 73 20 6f 6e 20 74 68 |el studi|es on th|
|00001820| 65 0d 0a 6c 6f 6e 67 2d | 74 65 72 6d 20 65 66 66 |e..long-|term eff|
|00001830| 65 63 74 73 20 6f 66 20 | 65 61 72 6c 79 20 6e 75 |ects of |early nu|
|00001840| 74 72 69 74 69 6f 6e 20 | 77 65 72 65 20 63 6f 6e |trition |were con|
|00001850| 64 75 63 74 65 64 20 69 | 6e 20 35 20 63 65 6e 74 |ducted i|n 5 cent|
|00001860| 65 72 73 2c 20 77 69 74 | 68 0d 0a 64 65 76 65 6c |ers, wit|h..devel|
|00001870| 6f 70 6d 65 6e 74 61 6c | 20 64 61 74 61 20 61 76 |opmental| data av|
|00001880| 61 69 6c 61 62 6c 65 20 | 61 74 20 31 38 20 6d 6f |ailable |at 18 mo|
|00001890| 6e 74 68 73 20 70 6f 73 | 74 20 74 65 72 6d 2e 20 |nths pos|t term. |
|000018a0| 20 41 20 74 6f 74 61 6c | 20 6f 66 20 34 32 34 20 | A total| of 424 |
|000018b0| 70 72 65 74 65 72 6d 0d | 0a 69 6e 66 61 6e 74 73 |preterm.|.infants|
|000018c0| 20 77 65 69 67 68 69 6e | 67 20 6c 65 73 73 20 74 | weighin|g less t|
|000018d0| 68 61 6e 20 31 2c 38 35 | 30 20 67 20 61 74 20 62 |han 1,85|0 g at b|
|000018e0| 69 72 74 68 20 77 65 72 | 65 20 73 74 75 64 69 65 |irth wer|e studie|
|000018f0| 64 2e 20 20 49 6e 66 61 | 6e 74 73 20 6f 66 20 6d |d. Infa|nts of m|
|00001900| 6f 74 68 65 72 73 0d 0a | 77 68 6f 20 63 68 6f 73 |others..|who chos|
|00001910| 65 20 6e 6f 74 20 74 6f | 20 62 72 65 61 73 74 2d |e not to| breast-|
|00001920| 66 65 65 64 20 77 65 72 | 65 20 72 61 6e 64 6f 6d |feed wer|e random|
|00001930| 6c 79 20 61 73 73 69 67 | 6e 65 64 20 74 6f 20 72 |ly assig|ned to r|
|00001940| 65 63 65 69 76 65 20 61 | 20 73 74 61 6e 64 61 72 |eceive a| standar|
|00001950| 64 0d 0a 22 74 65 72 6d | 22 20 66 6f 72 6d 75 6c |d.."term|" formul|
|00001960| 61 20 6f 72 20 61 20 6e | 75 74 72 69 65 6e 74 2d |a or a n|utrient-|
|00001970| 65 6e 72 69 63 68 65 64 | 20 22 70 72 65 74 65 72 |enriched| "preter|
|00001980| 6d 22 20 66 6f 72 6d 75 | 6c 61 20 61 73 20 74 68 |m" formu|la as th|
|00001990| 65 20 73 6f 6c 65 20 64 | 69 65 74 0d 0a 28 74 72 |e sole d|iet..(tr|
|000019a0| 69 61 6c 20 41 29 2e 20 | 20 49 6e 20 74 68 65 20 |ial A). | In the |
|000019b0| 73 65 63 6f 6e 64 20 73 | 74 75 64 79 2c 20 69 6e |second s|tudy, in|
|000019c0| 66 61 6e 74 73 20 77 68 | 6f 73 65 20 6d 6f 74 68 |fants wh|ose moth|
|000019d0| 65 72 73 20 63 68 6f 73 | 65 20 74 6f 20 62 72 65 |ers chos|e to bre|
|000019e0| 61 73 74 2d 66 65 65 64 | 0d 0a 77 65 72 65 20 72 |ast-feed|..were r|
|000019f0| 61 6e 64 6f 6d 6c 79 20 | 61 6c 6c 6f 63 61 74 65 |andomly |allocate|
|00001a00| 64 20 74 6f 20 74 65 72 | 6d 20 6f 72 20 70 72 65 |d to ter|m or pre|
|00001a10| 74 65 72 6d 20 66 6f 72 | 6d 75 6c 61 20 61 73 20 |term for|mula as |
|00001a20| 61 20 73 75 70 70 6c 65 | 6d 65 6e 74 20 74 6f 20 |a supple|ment to |
|00001a30| 74 68 65 0d 0a 6d 6f 74 | 68 65 72 27 73 20 6f 77 |the..mot|her's ow|
|00001a40| 6e 20 6d 69 6c 6b 20 28 | 74 72 69 61 6c 20 42 29 |n milk (|trial B)|
|00001a50| 3b 20 74 68 65 20 6d 65 | 64 69 61 6e 20 69 6e 74 |; the me|dian int|
|00001a60| 61 6b 65 20 6f 66 20 6d | 6f 74 68 65 72 27 73 20 |ake of m|other's |
|00001a70| 6d 69 6c 6b 20 64 69 64 | 20 6e 6f 74 20 64 69 66 |milk did| not dif|
|00001a80| 66 65 72 0d 0a 62 65 74 | 77 65 65 6e 20 69 6e 66 |fer..bet|ween inf|
|00001a90| 61 6e 74 73 20 67 69 76 | 65 6e 20 74 65 72 6d 20 |ants giv|en term |
|00001aa0| 61 6e 64 20 70 72 65 74 | 65 72 6d 20 66 6f 72 6d |and pret|erm form|
|00001ab0| 75 6c 61 2e 0d 0a 20 20 | 20 20 20 41 20 74 6f 74 |ula... | A tot|
|00001ac0| 61 6c 20 6f 66 20 33 37 | 37 20 73 75 72 76 69 76 |al of 37|7 surviv|
|00001ad0| 6f 72 73 20 77 65 72 65 | 20 61 76 61 69 6c 61 62 |ors were| availab|
|00001ae0| 6c 65 20 66 6f 72 20 31 | 38 2d 6d 6f 6e 74 68 20 |le for 1|8-month |
|00001af0| 70 6f 73 74 2d 74 65 72 | 6d 20 65 76 61 6c 75 61 |post-ter|m evalua|
|00001b00| 74 69 6f 6e 0d 0a 28 6d | 65 64 69 61 6e 20 61 67 |tion..(m|edian ag|
|00001b10| 65 2c 20 38 32 2e 36 20 | 77 65 65 6b 73 29 2e 20 |e, 82.6 |weeks). |
|00001b20| 20 57 65 69 67 68 74 20 | 67 61 69 6e 20 61 6e 64 | Weight |gain and|
|00001b30| 20 68 65 61 64 20 67 72 | 6f 77 74 68 20 77 65 72 | head gr|owth wer|
|00001b40| 65 20 73 69 67 6e 69 66 | 69 63 61 6e 74 6c 79 0d |e signif|icantly.|
|00001b50| 0a 66 61 73 74 65 72 20 | 69 6e 20 69 6e 66 61 6e |.faster |in infan|
|00001b60| 74 73 20 66 65 64 20 70 | 72 65 74 65 72 6d 20 66 |ts fed p|reterm f|
|00001b70| 6f 72 6d 75 6c 61 20 74 | 68 61 6e 20 69 6e 20 74 |ormula t|han in t|
|00001b80| 68 6f 73 65 20 66 65 64 | 20 73 74 61 6e 64 61 72 |hose fed| standar|
|00001b90| 64 20 66 6f 72 6d 75 6c | 61 20 69 6e 0d 0a 62 6f |d formul|a in..bo|
|00001ba0| 74 68 20 74 72 69 61 6c | 73 2e 20 20 49 6e 66 61 |th trial|s. Infa|
|00001bb0| 6e 74 73 20 66 65 64 20 | 70 72 65 74 65 72 6d 20 |nts fed |preterm |
|00001bc0| 66 6f 72 6d 75 6c 61 20 | 68 61 64 20 73 69 67 6e |formula |had sign|
|00001bd0| 69 66 69 63 61 6e 74 6c | 79 20 68 69 67 68 65 72 |ificantl|y higher|
|00001be0| 20 42 61 79 6c 65 79 0d | 0a 73 63 6f 72 65 73 20 | Bayley.|.scores |
|00001bf0| 6f 6e 20 6d 65 6e 74 61 | 6c 20 61 6e 64 20 70 73 |on menta|l and ps|
|00001c00| 79 63 68 6f 6d 6f 74 6f | 72 20 64 65 76 65 6c 6f |ychomoto|r develo|
|00001c10| 70 6d 65 6e 74 20 69 6e | 64 69 63 65 73 20 28 46 |pment in|dices (F|
|00001c20| 69 67 20 31 37 2d 32 29 | 20 61 6e 64 20 73 6f 63 |ig 17-2)| and soc|
|00001c30| 69 61 6c 0d 0a 71 75 6f | 74 69 65 6e 74 73 2c 20 |ial..quo|tients, |
|00001c40| 61 73 20 63 6f 6d 70 61 | 72 65 64 20 77 69 74 68 |as compa|red with|
|00001c50| 20 69 6e 66 61 6e 74 73 | 20 66 65 64 20 74 65 72 | infants| fed ter|
|00001c60| 6d 20 66 6f 72 6d 75 6c | 61 2e 20 20 54 68 65 73 |m formul|a. Thes|
|00001c70| 65 20 61 64 76 61 6e 74 | 61 67 65 73 20 77 65 72 |e advant|ages wer|
|00001c80| 65 0d 0a 70 61 72 74 69 | 63 75 6c 61 72 6c 79 20 |e..parti|cularly |
|00001c90| 73 74 72 69 6b 69 6e 67 | 20 69 6e 20 73 6d 61 6c |striking| in smal|
|00001ca0| 6c 2d 66 6f 72 2d 67 65 | 73 74 61 74 69 6f 6e 61 |l-for-ge|stationa|
|00001cb0| 6c 20 61 67 65 20 69 6e | 66 61 6e 74 73 20 61 6e |l age in|fants an|
|00001cc0| 64 20 6d 61 6c 65 73 2e | 20 20 49 6e 0d 0a 74 72 |d males.| In..tr|
|00001cd0| 69 61 6c 20 41 2c 20 69 | 6e 66 61 6e 74 73 20 66 |ial A, i|nfants f|
|00001ce0| 65 64 20 70 72 65 74 65 | 72 6d 20 66 6f 72 6d 75 |ed prete|rm formu|
|00001cf0| 6c 61 20 68 61 64 20 61 | 20 31 35 2d 70 6f 69 6e |la had a| 15-poin|
|00001d00| 74 20 61 64 76 61 6e 74 | 61 67 65 20 69 6e 20 6d |t advant|age in m|
|00001d10| 6f 74 6f 72 0d 0a 64 65 | 76 65 6c 6f 70 6d 65 6e |otor..de|velopmen|
|00001d20| 74 20 69 6e 64 65 78 20 | 63 6f 6d 70 61 72 65 64 |t index |compared|
|00001d30| 20 77 69 74 68 20 69 6e | 66 61 6e 74 73 20 66 65 | with in|fants fe|
|00001d40| 64 20 74 65 72 6d 20 66 | 6f 72 6d 75 6c 61 3b 20 |d term f|ormula; |
|00001d50| 66 6f 72 20 69 6e 66 61 | 6e 74 73 20 62 6f 72 6e |for infa|nts born|
|00001d60| 0d 0a 73 6d 61 6c 6c 20 | 66 6f 72 20 67 65 73 74 |..small |for gest|
|00001d70| 61 74 69 6f 6e 2c 20 74 | 68 69 73 20 61 64 76 61 |ation, t|his adva|
|00001d80| 6e 74 61 67 65 20 77 61 | 73 20 32 33 20 70 6f 69 |ntage wa|s 23 poi|
|00001d90| 6e 74 73 2e 20 20 49 6e | 66 61 6e 74 73 20 66 65 |nts. In|fants fe|
|00001da0| 64 20 70 72 65 74 65 72 | 6d 0d 0a 66 6f 72 6d 75 |d preter|m..formu|
|00001db0| 6c 61 20 68 61 64 20 61 | 20 6c 6f 77 65 72 20 66 |la had a| lower f|
|00001dc0| 72 65 71 75 65 6e 63 79 | 20 6f 66 20 6d 6f 64 65 |requency| of mode|
|00001dd0| 72 61 74 65 20 64 65 76 | 65 6c 6f 70 6d 65 6e 74 |rate dev|elopment|
|00001de0| 61 6c 20 69 6d 70 61 69 | 72 6d 65 6e 74 20 28 32 |al impai|rment (2|
|00001df0| 39 25 29 20 74 68 61 6e | 0d 0a 69 6e 66 61 6e 74 |9%) than|..infant|
|00001e00| 73 20 66 65 64 20 74 65 | 72 6d 20 66 6f 72 6d 75 |s fed te|rm formu|
|00001e10| 6c 61 20 28 35 38 25 29 | 2e 20 20 54 68 65 72 65 |la (58%)|. There|
|00001e20| 20 77 61 73 20 61 6c 73 | 6f 20 61 20 73 6d 61 6c | was als|o a smal|
|00001e30| 6c 20 62 65 6e 65 66 69 | 74 20 69 6e 20 73 6f 63 |l benefi|t in soc|
|00001e40| 69 61 6c 0d 0a 6d 61 74 | 75 72 69 74 79 20 71 75 |ial..mat|urity qu|
|00001e50| 6f 74 69 65 6e 74 20 69 | 6e 20 69 6e 66 61 6e 74 |otient i|n infant|
|00001e60| 73 20 66 65 64 20 70 72 | 65 74 65 72 6d 20 66 6f |s fed pr|eterm fo|
|00001e70| 72 6d 75 6c 61 2e 20 20 | 41 20 73 68 6f 72 74 20 |rmula. |A short |
|00001e80| 70 65 72 69 6f 64 20 6f | 66 20 64 69 65 74 61 72 |period o|f dietar|
|00001e90| 79 0d 0a 6d 61 6e 69 70 | 75 6c 61 74 69 6f 6e 20 |y..manip|ulation |
|00001ea0| 69 6e 20 70 72 65 74 65 | 72 6d 20 69 6e 66 61 6e |in prete|rm infan|
|00001eb0| 74 73 20 68 61 73 20 61 | 20 73 69 67 6e 69 66 69 |ts has a| signifi|
|00001ec0| 63 61 6e 74 20 69 6d 70 | 61 63 74 20 6f 6e 20 64 |cant imp|act on d|
|00001ed0| 65 76 65 6c 6f 70 6d 65 | 6e 74 61 6c 0d 0a 73 74 |evelopme|ntal..st|
|00001ee0| 61 74 75 73 20 61 74 20 | 31 38 20 6d 6f 6e 74 68 |atus at |18 month|
|00001ef0| 73 3b 20 74 68 65 72 65 | 66 6f 72 65 2c 20 74 68 |s; there|fore, th|
|00001f00| 65 20 66 69 72 73 74 20 | 77 65 65 6b 73 20 6f 66 |e first |weeks of|
|00001f10| 20 6c 69 66 65 20 6d 61 | 79 20 62 65 20 63 72 69 | life ma|y be cri|
|00001f20| 74 69 63 61 6c 20 66 6f | 72 0d 0a 6e 75 74 72 69 |tical fo|r..nutri|
|00001f30| 74 69 6f 6e 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |tion....|.Post-Co|
|00001f40| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 52 69 |mment...|. Ri|
|00001f50| 63 68 61 72 64 20 55 6d | 61 6e 73 6b 79 2c 20 4d |chard Um|ansky, M|
|00001f60| 2e 44 2e 2c 20 44 69 72 | 65 63 74 6f 72 20 6f 66 |.D., Dir|ector of|
|00001f70| 20 74 68 65 20 44 69 76 | 69 73 69 6f 6e 20 6f 66 | the Div|ision of|
|00001f80| 20 43 68 69 6c 64 20 44 | 65 76 65 6c 6f 70 6d 65 | Child D|evelopme|
|00001f90| 6e 74 2c 0d 0a 43 68 69 | 6c 64 72 65 6e 27 73 20 |nt,..Chi|ldren's |
|00001fa0| 48 6f 73 70 69 74 61 6c | 20 4f 61 6b 6c 61 6e 64 |Hospital| Oakland|
|00001fb0| 2c 20 4f 61 6b 6c 61 6e | 64 2c 20 43 61 6c 69 66 |, Oaklan|d, Calif|
|00001fc0| 6f 72 6e 69 61 2c 20 6f | 66 66 65 72 73 20 68 69 |ornia, o|ffers hi|
|00001fd0| 73 20 74 68 6f 75 67 68 | 74 73 3a 20 20 49 74 20 |s though|ts: It |
|00001fe0| 69 73 0d 0a 73 74 69 6c | 6c 20 72 65 6c 61 74 69 |is..stil|l relati|
|00001ff0| 76 65 6c 79 20 72 61 72 | 65 20 66 6f 72 20 63 6c |vely rar|e for cl|
|00002000| 69 6e 69 63 61 6c 20 73 | 74 75 64 69 65 73 20 74 |inical s|tudies t|
|00002010| 6f 20 65 78 61 6d 69 6e | 65 20 74 68 65 20 76 61 |o examin|e the va|
|00002020| 6c 69 64 69 74 79 20 6f | 66 0d 0a 65 73 74 61 62 |lidity o|f..estab|
|00002030| 6c 69 73 68 65 64 20 70 | 72 61 63 74 69 63 65 73 |lished p|ractices|
|00002040| 2e 20 20 54 68 69 73 20 | 69 6d 70 6f 72 74 61 6e |. This |importan|
|00002050| 74 20 73 74 75 64 79 20 | 70 72 6f 76 69 64 65 73 |t study |provides|
|00002060| 20 65 76 69 64 65 6e 63 | 65 20 6f 66 20 74 68 65 | evidenc|e of the|
|00002070| 0d 0a 64 65 76 65 6c 6f | 70 6d 65 6e 74 61 6c 20 |..develo|pmental |
|00002080| 76 61 6c 75 65 20 74 6f | 20 70 72 65 6d 61 74 75 |value to| prematu|
|00002090| 72 65 20 69 6e 66 61 6e | 74 73 20 6f 66 20 61 20 |re infan|ts of a |
|000020a0| 72 65 6c 61 74 69 76 65 | 6c 79 20 73 68 6f 72 74 |relative|ly short|
|000020b0| 20 65 78 70 6f 73 75 72 | 65 20 65 61 72 6c 79 0d | exposur|e early.|
|000020c0| 0a 69 6e 20 69 6e 66 61 | 6e 63 79 20 74 6f 20 74 |.in infa|ncy to t|
|000020d0| 68 65 20 74 79 70 65 20 | 6f 66 20 6e 75 74 72 69 |he type |of nutri|
|000020e0| 74 69 6f 6e 61 6c 6c 79 | 20 65 6e 72 69 63 68 65 |tionally| enriche|
|000020f0| 64 20 70 72 65 74 65 72 | 6d 20 66 6f 72 6d 75 6c |d preter|m formul|
|00002100| 61 20 28 50 54 46 29 20 | 69 6e 0d 0a 67 65 6e 65 |a (PTF) |in..gene|
|00002110| 72 61 6c 20 75 73 65 20 | 69 6e 20 6d 61 6e 79 20 |ral use |in many |
|00002120| 70 61 72 74 73 20 6f 66 | 20 74 68 65 20 77 6f 72 |parts of| the wor|
|00002130| 6c 64 2e 20 20 54 68 65 | 20 72 65 73 75 6c 74 73 |ld. The| results|
|00002140| 20 77 65 72 65 20 6d 6f | 73 74 20 70 72 6f 6e 6f | were mo|st prono|
|00002150| 75 6e 63 65 64 20 69 6e | 0d 0a 73 6d 61 6c 6c 2d |unced in|..small-|
|00002160| 66 6f 72 2d 64 61 74 65 | 73 20 61 6e 64 20 6d 61 |for-date|s and ma|
|00002170| 6c 65 20 69 6e 66 61 6e | 74 73 2c 20 77 68 6f 73 |le infan|ts, whos|
|00002180| 65 20 42 61 79 6c 65 79 | 20 6d 65 6e 74 61 6c 20 |e Bayley| mental |
|00002190| 61 6e 64 20 6d 6f 74 6f | 72 20 73 63 6f 72 65 73 |and moto|r scores|
|000021a0| 0d 0a 69 6d 70 72 6f 76 | 65 64 2e 20 20 54 68 65 |..improv|ed. The|
|000021b0| 79 20 77 65 72 65 20 6c | 65 73 73 20 63 6c 65 61 |y were l|ess clea|
|000021c0| 72 2d 63 75 74 20 69 6e | 20 69 6e 66 61 6e 74 73 |r-cut in| infants|
|000021d0| 20 77 68 6f 20 72 65 63 | 65 69 76 65 64 20 62 72 | who rec|eived br|
|000021e0| 65 61 73 74 20 6d 69 6c | 6b 2e 0d 0a 20 20 20 20 |east mil|k... |
|000021f0| 20 53 65 76 65 72 61 6c | 20 70 6f 69 6e 74 73 20 | Several| points |
|00002200| 72 65 71 75 69 72 65 20 | 65 6d 70 68 61 73 69 73 |require |emphasis|
|00002210| 3a 20 20 46 69 72 73 74 | 2c 20 61 73 20 74 68 65 |: First|, as the|
|00002220| 20 61 75 74 68 6f 72 73 | 20 6e 6f 74 65 2c 20 74 | authors| note, t|
|00002230| 68 65 20 73 74 75 64 79 | 0d 0a 77 61 73 20 6e 6f |he study|..was no|
|00002240| 74 20 64 65 73 69 67 6e | 65 64 20 74 6f 20 64 65 |t design|ed to de|
|00002250| 74 65 72 6d 69 6e 65 20 | 77 68 69 63 68 20 63 6f |termine |which co|
|00002260| 6e 73 74 69 74 75 65 6e | 74 73 20 6f 66 20 74 68 |nstituen|ts of th|
|00002270| 65 20 50 54 46 20 77 65 | 72 65 20 63 72 75 63 69 |e PTF we|re cruci|
|00002280| 61 6c 20 69 6e 0d 0a 63 | 6f 6e 66 65 72 72 69 6e |al in..c|onferrin|
|00002290| 67 20 74 68 65 20 64 65 | 76 65 6c 6f 70 6d 65 6e |g the de|velopmen|
|000022a0| 74 61 6c 20 61 64 76 61 | 6e 74 61 67 65 2e 0d 0a |tal adva|ntage...|
|000022b0| 20 20 20 20 20 53 65 63 | 6f 6e 64 2c 20 6f 6e 65 | Sec|ond, one|
|000022c0| 20 77 6f 6e 64 65 72 73 | 20 77 68 65 74 68 65 72 | wonders| whether|
|000022d0| 20 74 68 65 20 69 6d 70 | 72 6f 76 65 64 20 64 65 | the imp|roved de|
|000022e0| 76 65 6c 6f 70 6d 65 6e | 74 20 61 73 73 6f 63 69 |velopmen|t associ|
|000022f0| 61 74 65 64 20 77 69 74 | 68 20 50 54 46 0d 0a 77 |ated wit|h PTF..w|
|00002300| 61 73 20 6d 65 64 69 61 | 74 65 64 20 74 68 72 6f |as media|ted thro|
|00002310| 75 67 68 20 62 65 74 74 | 65 72 20 70 68 79 73 69 |ugh bett|er physi|
|00002320| 63 61 6c 20 67 72 6f 77 | 74 68 3b 20 50 54 46 20 |cal grow|th; PTF |
|00002330| 72 65 73 75 6c 74 65 64 | 20 69 6e 20 62 65 74 74 |resulted| in bett|
|00002340| 65 72 20 77 65 69 67 68 | 74 0d 0a 67 61 69 6e 20 |er weigh|t..gain |
|00002350| 61 6e 64 20 68 65 61 64 | 20 63 69 72 63 75 6d 66 |and head| circumf|
|00002360| 65 72 65 6e 63 65 20 67 | 72 6f 77 74 68 20 64 75 |erence g|rowth du|
|00002370| 72 69 6e 67 20 69 74 73 | 20 75 73 65 2c 20 62 75 |ring its| use, bu|
|00002380| 74 20 74 68 65 72 65 20 | 77 61 73 20 6e 6f 0d 0a |t there |was no..|
|00002390| 63 6f 72 72 65 6c 61 74 | 69 6f 6e 20 62 65 74 77 |correlat|ion betw|
|000023a0| 65 65 6e 20 73 75 63 68 | 20 65 61 72 6c 79 20 69 |een such| early i|
|000023b0| 6e 64 69 63 61 74 6f 72 | 73 20 6f 66 20 69 6d 70 |ndicator|s of imp|
|000023c0| 72 6f 76 65 64 20 67 72 | 6f 77 74 68 20 61 6e 64 |roved gr|owth and|
|000023d0| 20 6c 61 74 65 72 0d 0a | 64 65 76 65 6c 6f 70 6d | later..|developm|
|000023e0| 65 6e 74 20 61 74 20 31 | 38 20 6d 6f 6e 74 68 73 |ent at 1|8 months|
|000023f0| 2e 20 20 41 6c 73 6f 2c | 20 74 68 69 73 20 73 74 |. Also,| this st|
|00002400| 75 64 79 20 64 69 64 20 | 6e 6f 74 20 65 78 61 6d |udy did |not exam|
|00002410| 69 6e 65 20 74 68 65 20 | 72 65 6c 61 74 69 6f 6e |ine the |relation|
|00002420| 73 68 69 70 0d 0a 62 65 | 74 77 65 65 6e 20 64 65 |ship..be|tween de|
|00002430| 76 65 6c 6f 70 6d 65 6e | 74 20 61 74 20 31 38 20 |velopmen|t at 18 |
|00002440| 6d 6f 6e 74 68 73 20 61 | 6e 64 20 70 68 79 73 69 |months a|nd physi|
|00002450| 63 61 6c 20 67 72 6f 77 | 74 68 20 73 74 61 74 75 |cal grow|th statu|
|00002460| 73 20 61 74 20 74 68 61 | 74 20 74 69 6d 65 2e 0d |s at tha|t time..|
|00002470| 0a 20 20 20 20 20 54 68 | 69 72 64 2c 20 61 6c 74 |. Th|ird, alt|
|00002480| 68 6f 75 67 68 20 74 68 | 65 20 69 6d 70 72 6f 76 |hough th|e improv|
|00002490| 65 6d 65 6e 74 20 63 6f | 6e 66 65 72 72 65 64 20 |ement co|nferred |
|000024a0| 62 79 20 50 54 46 20 75 | 73 65 20 6f 6e 20 31 38 |by PTF u|se on 18|
|000024b0| 2d 6d 6f 6e 74 68 20 42 | 61 79 6c 65 79 0d 0a 6d |-month B|ayley..m|
|000024c0| 6f 74 6f 72 20 73 63 6f | 72 65 73 20 77 61 73 20 |otor sco|res was |
|000024d0| 67 72 65 61 74 65 72 20 | 74 68 61 6e 20 6f 6e 20 |greater |than on |
|000024e0| 42 61 79 6c 65 79 20 6d | 65 6e 74 61 6c 20 73 63 |Bayley m|ental sc|
|000024f0| 6f 72 65 73 2c 20 69 74 | 20 6d 61 79 20 62 65 20 |ores, it| may be |
|00002500| 6c 65 73 73 0d 0a 6d 65 | 61 6e 69 6e 67 66 75 6c |less..me|aningful|
|00002510| 2e 20 20 41 74 20 74 68 | 69 73 20 61 67 65 2c 20 |. At th|is age, |
|00002520| 74 68 65 20 42 61 79 6c | 65 79 20 4d 6f 74 6f 72 |the Bayl|ey Motor|
|00002530| 20 53 63 61 6c 65 20 69 | 73 20 62 61 73 65 64 20 | Scale i|s based |
|00002540| 6f 6e 20 63 6f 6d 70 61 | 72 61 74 69 76 65 6c 79 |on compa|ratively|
|00002550| 20 66 65 77 0d 0a 69 74 | 65 6d 73 2c 20 70 72 69 | few..it|ems, pri|
|00002560| 6d 61 72 69 6c 79 20 6d | 65 61 73 75 72 65 73 20 |marily m|easures |
|00002570| 6f 66 20 65 71 75 69 6c | 69 62 72 69 75 6d 20 61 |of equil|ibrium a|
|00002580| 6e 64 20 73 74 72 65 6e | 67 74 68 2c 20 61 6e 64 |nd stren|gth, and|
|00002590| 20 69 73 20 6e 6f 74 20 | 61 20 67 65 6e 65 72 61 | is not |a genera|
|000025a0| 6c 0d 0a 61 73 73 65 73 | 73 6d 65 6e 74 20 6f 66 |l..asses|sment of|
|000025b0| 20 67 72 6f 73 73 20 6d | 6f 74 6f 72 20 61 62 69 | gross m|otor abi|
|000025c0| 6c 69 74 69 65 73 2e 20 | 20 4f 6e 20 74 68 65 20 |lities. | On the |
|000025d0| 6f 74 68 65 72 20 68 61 | 6e 64 2c 20 61 74 20 31 |other ha|nd, at 1|
|000025e0| 38 20 6d 6f 6e 74 68 73 | 2c 20 74 68 65 0d 0a 42 |8 months|, the..B|
|000025f0| 61 79 6c 65 79 20 4d 65 | 6e 74 61 6c 20 53 63 61 |ayley Me|ntal Sca|
|00002600| 6c 65 20 69 73 20 62 61 | 73 65 64 20 6f 6e 20 73 |le is ba|sed on s|
|00002610| 65 76 65 72 61 6c 20 74 | 69 6d 65 73 20 74 68 65 |everal t|imes the|
|00002620| 20 6e 75 6d 62 65 72 20 | 6f 66 20 69 74 65 6d 73 | number |of items|
|00002630| 20 61 6e 64 20 61 73 73 | 65 73 73 20 61 0d 0a 77 | and ass|ess a..w|
|00002640| 69 64 65 20 76 61 72 69 | 65 74 79 20 6f 66 20 63 |ide vari|ety of c|
|00002650| 6f 67 6e 69 74 69 76 65 | 20 61 6e 64 20 65 61 72 |ognitive| and ear|
|00002660| 6c 79 20 6c 61 6e 67 75 | 61 67 65 20 73 6b 69 6c |ly langu|age skil|
|00002670| 6c 73 20 61 73 20 77 65 | 6c 6c 20 61 73 20 69 6e |ls as we|ll as in|
|00002680| 63 6f 72 70 6f 72 61 74 | 69 6e 67 20 61 0d 0a 73 |corporat|ing a..s|
|00002690| 75 62 73 74 61 6e 74 69 | 61 6c 20 66 69 6e 65 20 |ubstanti|al fine |
|000026a0| 6d 6f 74 6f 72 20 63 6f | 6d 70 6f 6e 65 6e 74 2e |motor co|mponent.|
|000026b0| 0d 0a 20 20 20 20 20 46 | 6f 75 72 74 68 2c 20 74 |.. F|ourth, t|
|000026c0| 68 65 20 64 65 76 65 6c | 6f 70 6d 65 6e 74 61 6c |he devel|opmental|
|000026d0| 20 61 64 76 61 6e 74 61 | 67 65 20 73 65 65 6e 20 | advanta|ge seen |
|000026e0| 69 6e 20 74 68 65 20 50 | 54 46 20 67 72 6f 75 70 |in the P|TF group|
|000026f0| 20 61 74 20 31 38 20 6d | 6f 6e 74 68 73 0d 0a 6d | at 18 m|onths..m|
|00002700| 61 79 20 6e 6f 74 20 62 | 65 20 73 75 73 74 61 69 |ay not b|e sustai|
|00002710| 6e 65 64 2e 20 20 41 73 | 20 6e 6f 74 65 64 20 62 |ned. As| noted b|
|00002720| 79 20 74 68 65 20 61 75 | 74 68 6f 72 73 2c 20 64 |y the au|thors, d|
|00002730| 65 76 65 6c 6f 70 6d 65 | 6e 74 61 6c 20 74 65 73 |evelopme|ntal tes|
|00002740| 74 69 6e 67 20 65 61 72 | 6c 79 20 69 6e 0d 0a 6c |ting ear|ly in..l|
|00002750| 69 66 65 20 69 73 20 6f | 66 20 6c 69 6d 69 74 65 |ife is o|f limite|
|00002760| 64 20 70 72 65 64 69 63 | 74 69 76 65 20 76 61 6c |d predic|tive val|
|00002770| 75 65 2e 20 20 41 74 20 | 31 38 20 6d 6f 6e 74 68 |ue. At |18 month|
|00002780| 73 20 6d 61 6e 79 20 61 | 74 74 72 69 62 75 74 65 |s many a|ttribute|
|00002790| 73 20 6f 66 20 6d 61 74 | 75 72 65 0d 0a 69 6e 74 |s of mat|ure..int|
|000027a0| 65 6c 6c 69 67 65 6e 63 | 65 20 61 72 65 20 6e 6f |elligenc|e are no|
|000027b0| 74 20 72 65 61 64 69 6c | 79 20 6d 65 61 73 75 72 |t readil|y measur|
|000027c0| 61 62 6c 65 20 6f 72 20 | 68 61 76 65 20 79 65 74 |able or |have yet|
|000027d0| 20 74 6f 20 65 6d 65 72 | 67 65 2c 20 65 2e 67 2e | to emer|ge, e.g.|
|000027e0| 2c 20 61 62 73 74 72 61 | 63 74 0d 0a 72 65 61 73 |, abstra|ct..reas|
|000027f0| 6f 6e 69 6e 67 2c 20 75 | 73 65 20 6f 66 20 73 79 |oning, u|se of sy|
|00002800| 6d 62 6f 6c 73 2c 20 72 | 65 66 6c 65 63 74 69 76 |mbols, r|eflectiv|
|00002810| 65 20 6a 75 64 67 6d 65 | 6e 74 2e 20 20 54 68 69 |e judgme|nt. Thi|
|00002820| 73 20 6d 61 79 20 62 65 | 20 74 72 75 65 20 65 73 |s may be| true es|
|00002830| 70 65 63 69 61 6c 6c 79 | 0d 0a 69 6e 20 70 72 65 |pecially|..in pre|
|00002840| 6d 61 74 75 72 65 20 69 | 6e 66 61 6e 74 73 20 62 |mature i|nfants b|
|00002850| 65 63 61 75 73 65 20 74 | 68 65 69 72 20 22 63 61 |ecause t|heir "ca|
|00002860| 74 63 68 2d 75 70 22 20 | 70 72 6f 63 65 73 73 20 |tch-up" |process |
|00002870| 69 73 20 6e 6f 74 20 79 | 65 74 20 63 6f 6d 70 6c |is not y|et compl|
|00002880| 65 74 65 20 61 74 0d 0a | 74 68 69 73 20 61 67 65 |ete at..|this age|
|00002890| 2e 0d 0a 20 20 20 20 20 | 46 69 6e 61 6c 6c 79 2c |... |Finally,|
|000028a0| 20 74 68 65 20 61 75 74 | 68 6f 72 73 20 69 6e 74 | the aut|hors int|
|000028b0| 65 72 70 72 65 74 20 74 | 68 65 20 56 69 6e 65 6c |erpret t|he Vinel|
|000028c0| 61 6e 64 20 72 65 73 75 | 6c 74 73 20 61 73 20 61 |and resu|lts as a|
|000028d0| 6e 20 69 6e 64 69 63 61 | 74 69 6f 6e 20 74 68 61 |n indica|tion tha|
|000028e0| 74 0d 0a 65 61 72 6c 79 | 20 64 69 65 74 20 6d 61 |t..early| diet ma|
|000028f0| 79 20 68 61 76 65 20 61 | 20 73 6d 61 6c 6c 20 62 |y have a| small b|
|00002900| 75 74 20 73 69 67 6e 69 | 66 69 63 61 6e 74 20 65 |ut signi|ficant e|
|00002910| 66 66 65 63 74 20 6f 6e | 20 68 6f 77 20 74 68 65 |ffect on| how the|
|00002920| 20 70 72 65 6d 61 74 75 | 72 65 20 69 6e 66 61 6e | prematu|re infan|
|00002930| 74 0d 0a 73 75 62 73 65 | 71 75 65 6e 74 6c 79 20 |t..subse|quently |
|00002940| 61 64 61 70 74 73 20 74 | 6f 20 69 74 73 20 65 6e |adapts t|o its en|
|00002950| 76 69 72 6f 6e 6d 65 6e | 74 2e 20 20 54 68 65 20 |vironmen|t. The |
|00002960| 56 69 6e 65 6c 61 6e 64 | 20 69 6e 73 74 72 75 6d |Vineland| instrum|
|00002970| 65 6e 74 20 69 73 20 61 | 0d 0a 71 75 65 73 74 69 |ent is a|..questi|
|00002980| 6f 6e 6e 61 69 72 65 20 | 61 64 6d 69 6e 69 73 74 |onnaire |administ|
|00002990| 65 72 65 64 20 74 6f 20 | 63 61 72 65 74 61 6b 65 |ered to |caretake|
|000029a0| 72 73 2e 20 20 53 75 70 | 70 6c 65 6d 65 6e 74 61 |rs. Sup|plementa|
|000029b0| 6c 20 69 6e 66 6f 72 6d | 61 74 69 6f 6e 20 66 72 |l inform|ation fr|
|000029c0| 6f 6d 20 74 68 65 0d 0a | 49 6e 66 61 6e 74 20 42 |om the..|Infant B|
|000029d0| 65 68 61 76 69 6f 72 61 | 6c 20 52 65 63 6f 72 64 |ehaviora|l Record|
|000029e0| 20 28 64 65 72 69 76 65 | 64 20 64 75 72 69 6e 67 | (derive|d during|
|000029f0| 20 42 61 79 6c 65 79 20 | 74 65 73 74 69 6e 67 29 | Bayley |testing)|
|00002a00| 20 77 6f 75 6c 64 20 68 | 61 76 65 20 62 65 65 6e | would h|ave been|
|00002a10| 20 6f 66 0d 0a 69 6e 74 | 65 72 65 73 74 2e 20 20 | of..int|erest. |
|00002a20| 54 68 69 73 20 72 65 63 | 6f 72 64 20 69 6e 63 6f |This rec|ord inco|
|00002a30| 72 70 6f 72 61 74 65 73 | 20 74 68 65 20 72 65 73 |rporates| the res|
|00002a40| 75 6c 74 73 20 6f 66 20 | 64 69 72 65 63 74 20 69 |ults of |direct i|
|00002a50| 6e 66 61 6e 74 20 6f 62 | 73 65 72 76 61 74 69 6f |nfant ob|servatio|
|00002a60| 6e 73 0d 0a 6f 66 20 69 | 6e 74 65 72 70 65 72 73 |ns..of i|nterpers|
|00002a70| 6f 6e 61 6c 20 72 65 73 | 70 6f 6e 73 69 76 65 6e |onal res|ponsiven|
|00002a80| 65 73 73 2c 20 65 6d 6f | 74 69 6f 6e 61 6c 20 74 |ess, emo|tional t|
|00002a90| 6f 6e 65 2c 20 61 74 74 | 65 6e 74 69 6f 6e 20 74 |one, att|ention t|
|00002aa0| 6f 20 6f 62 6a 65 63 74 | 73 20 61 6e 64 0d 0a 67 |o object|s and..g|
|00002ab0| 6f 61 6c 73 2c 20 61 6e | 64 20 61 63 74 69 76 69 |oals, an|d activi|
|00002ac0| 74 79 20 6c 65 76 65 6c | 2e 0d 0a 20 20 20 20 20 |ty level|... |
|00002ad0| 54 68 65 20 61 75 74 68 | 6f 72 73 20 73 68 6f 75 |The auth|ors shou|
|00002ae0| 6c 64 20 62 65 20 63 6f | 6e 67 72 61 74 75 6c 61 |ld be co|ngratula|
|00002af0| 74 65 64 20 66 6f 72 20 | 70 75 72 73 75 69 6e 67 |ted for |pursuing|
|00002b00| 20 74 68 69 73 20 76 61 | 6c 75 61 62 6c 65 20 65 | this va|luable e|
|00002b10| 66 66 6f 72 74 2e 0d 0a | 4f 6e 65 20 6c 6f 6f 6b |ffort...|One look|
|00002b20| 73 20 66 6f 72 77 61 72 | 64 20 77 69 74 68 20 61 |s forwar|d with a|
|00002b30| 6e 74 69 63 69 70 61 74 | 69 6f 6e 20 74 6f 20 69 |nticipat|ion to i|
|00002b40| 6e 66 6f 72 6d 61 74 69 | 6f 6e 20 74 6f 20 63 6f |nformati|on to co|
|00002b50| 6d 65 20 66 72 6f 6d 20 | 66 75 72 74 68 65 72 0d |me from |further.|
|00002b60| 0a 66 6f 6c 6c 6f 77 2d | 75 70 20 6f 66 20 74 68 |.follow-|up of th|
|00002b70| 65 73 65 20 79 6f 75 6e | 67 73 74 65 72 73 20 69 |ese youn|gsters i|
|00002b80| 6e 20 74 68 65 20 70 72 | 65 73 63 68 6f 6f 6c 20 |n the pr|eschool |
|00002b90| 61 6e 64 20 73 63 68 6f | 6f 6c 20 61 67 65 20 79 |and scho|ol age y|
|00002ba0| 65 61 72 73 2e 2d 2d 52 | 2e 0d 0a 55 6d 61 6e 73 |ears.--R|...Umans|
|00002bb0| 6b 79 2c 20 4d 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |ky, M.D.|..$Uniqu|
|00002bc0| 65 5f 49 44 7b 59 52 42 | 30 32 34 30 32 7d 0d 0a |e_ID{YRB|02402}..|
|00002bd0| 24 54 69 74 6c 65 7b 42 | 69 72 74 68 77 65 69 67 |$Title{B|irthweig|
|00002be0| 68 74 20 53 70 65 63 69 | 66 69 63 20 54 72 65 6e |ht Speci|fic Tren|
|00002bf0| 64 73 20 69 6e 20 43 65 | 72 65 62 72 61 6c 20 50 |ds in Ce|rebral P|
|00002c00| 61 6c 73 79 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 0d |alsy}..$|Author{.|
|00002c10| 0a 50 68 61 72 6f 61 68 | 2c 20 50 4f 44 0d 0a 43 |.Pharoah|, POD..C|
|00002c20| 6f 6f 6b 65 2c 20 54 0d | 0a 43 6f 6f 6b 65 2c 20 |ooke, T.|.Cooke, |
|00002c30| 52 57 49 0d 0a 52 6f 73 | 65 6e 62 6c 6f 6f 6d 2c |RWI..Ros|enbloom,|
|00002c40| 20 4c 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f | L}..$Af|filiatio|
|00002c50| 6e 7b 55 6e 69 76 20 6f | 66 20 4c 69 76 65 72 70 |n{Univ o|f Liverp|
|00002c60| 6f 6f 6c 2c 20 45 6e 67 | 6c 61 6e 64 7d 0d 0a 24 |ool, Eng|land}..$|
|00002c70| 4a 6f 75 72 6e 61 6c 7b | 41 72 63 68 20 44 69 73 |Journal{|Arch Dis|
|00002c80| 20 43 68 69 6c 64 7d 0d | 0a 24 56 6f 6c 75 6d 65 | Child}.|.$Volume|
|00002c90| 7b 36 35 7d 0d 0a 24 50 | 61 67 65 7b 36 30 32 2d |{65}..$P|age{602-|
|00002ca0| 36 30 36 7d 0d 0a 24 44 | 61 74 65 7b 31 39 39 30 |606}..$D|ate{1990|
|00002cb0| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 39 31 20 59 |}..$YBVo|l{1991 Y|
|00002cc0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 4e 65 6f 6e |ear Book| of Neon|
|00002cd0| 61 74 61 6c 20 61 6e 64 | 20 50 65 72 69 6e 61 74 |atal and| Perinat|
|00002ce0| 61 6c 20 4d 65 64 69 63 | 69 6e 65 7d 0d 0a 24 43 |al Medic|ine}..$C|
|00002cf0| 68 61 70 74 65 72 7b 31 | 37 2d 31 33 7d 0d 0a 24 |hapter{1|7-13}..$|
|00002d00| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 4b 6c |YBEditor|{Drs. Kl|
|00002d10| 61 75 73 20 61 6e 64 20 | 46 61 6e 61 72 6f 66 66 |aus and |Fanaroff|
|00002d20| 7d 0d 0a 24 54 61 62 6c | 65 7b 7d 0d 0a 24 43 6f |}..$Tabl|e{}..$Co|
|00002d30| 6d 6d 65 6e 74 61 74 6f | 72 7b 4d 2e 48 2e 20 4b |mmentato|r{M.H. K|
|00002d40| 6c 61 75 73 2c 20 4d 2e | 44 2e 7d 0d 0a 0d 0a 43 |laus, M.|D.}....C|
|00002d50| 6f 70 79 72 69 67 68 74 | 20 28 43 29 20 59 65 61 |opyright| (C) Yea|
|00002d60| 72 20 42 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |r Book M|edical P|
|00002d70| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 20 |ublisher|s, Inc. |
|00002d80| 31 39 39 31 0d 0a 0d 0a | 31 39 39 31 20 59 65 61 |1991....|1991 Yea|
|00002d90| 72 20 42 6f 6f 6b 20 6f | 66 20 4e 65 6f 6e 61 74 |r Book o|f Neonat|
|00002da0| 61 6c 20 61 6e 64 20 50 | 65 72 69 6e 61 74 61 6c |al and P|erinatal|
|00002db0| 20 4d 65 64 69 63 69 6e | 65 0d 0a 0d 0a 43 68 61 | Medicin|e....Cha|
|00002dc0| 70 74 65 72 20 31 37 20 | 2d 2d 20 4f 75 74 63 6f |pter 17 |-- Outco|
|00002dd0| 6d 65 20 2d 2d 20 50 6f | 73 74 6e 61 74 61 6c 20 |me -- Po|stnatal |
|00002de0| 47 72 6f 77 74 68 20 61 | 6e 64 20 44 65 76 65 6c |Growth a|nd Devel|
|00002df0| 6f 70 6d 65 6e 74 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |opment..|..------|
|00002e00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002e10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002e20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002e30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002e40| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 42 69 72 74 68 77 |--------|..Birthw|
|00002e50| 65 69 67 68 74 20 53 70 | 65 63 69 66 69 63 20 54 |eight Sp|ecific T|
|00002e60| 72 65 6e 64 73 20 69 6e | 20 43 65 72 65 62 72 61 |rends in| Cerebra|
|00002e70| 6c 20 50 61 6c 73 79 0d | 0a 0d 0a 50 68 61 72 6f |l Palsy.|...Pharo|
|00002e80| 61 68 20 50 4f 44 3b 20 | 43 6f 6f 6b 65 20 54 3b |ah POD; |Cooke T;|
|00002e90| 20 43 6f 6f 6b 65 20 52 | 57 49 3b 20 52 6f 73 65 | Cooke R|WI; Rose|
|00002ea0| 6e 62 6c 6f 6f 6d 20 4c | 0d 0a 28 55 6e 69 76 20 |nbloom L|..(Univ |
|00002eb0| 6f 66 20 4c 69 76 65 72 | 70 6f 6f 6c 2c 20 45 6e |of Liver|pool, En|
|00002ec0| 67 6c 61 6e 64 29 0d 0a | 41 72 63 68 20 44 69 73 |gland)..|Arch Dis|
|00002ed0| 20 43 68 69 6c 64 20 36 | 35 3a 36 30 32 2d 36 30 | Child 6|5:602-60|
|00002ee0| 36 2c 20 31 39 39 30 0d | 0a 2d 2d 2d 2d 2d 2d 2d |6, 1990.|.-------|
|00002ef0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f30| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00002f40| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 44 65 73 70 |act.... | Desp|
|00002f50| 69 74 65 20 74 68 65 20 | 6f 76 65 72 61 6c 6c 20 |ite the |overall |
|00002f60| 69 6d 70 72 6f 76 65 6d | 65 6e 74 20 69 6e 20 70 |improvem|ent in p|
|00002f70| 72 6f 76 69 73 69 6f 6e | 73 20 66 6f 72 20 6e 65 |rovision|s for ne|
|00002f80| 6f 6e 61 74 61 6c 20 63 | 61 72 65 20 74 68 61 74 |onatal c|are that|
|00002f90| 20 68 61 73 0d 0a 72 65 | 73 75 6c 74 65 64 20 69 | has..re|sulted i|
|00002fa0| 6e 20 69 6d 70 72 6f 76 | 65 64 20 73 75 72 76 69 |n improv|ed survi|
|00002fb0| 76 61 6c 20 72 61 74 65 | 73 2c 20 74 68 65 20 70 |val rate|s, the p|
|00002fc0| 72 65 76 61 6c 65 6e 63 | 65 20 6f 66 20 63 65 72 |revalenc|e of cer|
|00002fd0| 65 62 72 61 6c 20 70 61 | 6c 73 79 20 69 6e 0d 0a |ebral pa|lsy in..|
|00002fe0| 6c 6f 77 2d 62 69 72 74 | 68 2d 77 65 69 67 68 74 |low-birt|h-weight|
|00002ff0| 20 69 6e 66 61 6e 74 73 | 20 69 73 20 69 6e 63 72 | infants| is incr|
|00003000| 65 61 73 69 6e 67 2c 20 | 77 69 74 68 20 32 35 25 |easing, |with 25%|
|00003010| 20 74 6f 20 34 30 25 20 | 6f 66 20 61 6c 6c 20 63 | to 40% |of all c|
|00003020| 61 73 65 73 20 6f 66 0d | 0a 63 65 72 65 62 72 61 |ases of.|.cerebra|
|00003030| 6c 20 70 61 6c 73 79 20 | 6f 63 63 75 72 72 69 6e |l palsy |occurrin|
|00003040| 67 20 69 6e 20 36 25 20 | 74 6f 20 37 25 20 6f 66 |g in 6% |to 7% of|
|00003050| 20 6c 6f 77 2d 62 69 72 | 74 68 20 77 65 69 67 68 | low-bir|th weigh|
|00003060| 74 20 69 6e 66 61 6e 74 | 73 2e 20 20 44 61 74 61 |t infant|s. Data|
|00003070| 20 77 65 72 65 0d 0a 61 | 6e 61 6c 79 7a 65 64 20 | were..a|nalyzed |
|00003080| 66 72 6f 6d 20 61 20 72 | 65 67 69 73 74 65 72 20 |from a r|egister |
|00003090| 6f 66 20 31 2c 30 35 36 | 20 69 6e 66 61 6e 74 73 |of 1,056| infants|
|000030a0| 20 77 69 74 68 20 63 65 | 72 65 62 72 61 6c 20 70 | with ce|rebral p|
|000030b0| 61 6c 73 79 20 62 6f 72 | 6e 20 74 6f 20 6d 6f 74 |alsy bor|n to mot|
|000030c0| 68 65 72 73 0d 0a 72 65 | 73 69 64 65 6e 74 20 69 |hers..re|sident i|
|000030d0| 6e 20 74 68 65 20 4d 65 | 72 73 65 79 20 72 65 67 |n the Me|rsey reg|
|000030e0| 69 6f 6e 20 66 72 6f 6d | 20 31 39 36 37 20 74 6f |ion from| 1967 to|
|000030f0| 20 31 39 38 34 2e 20 20 | 4f 6e 65 20 68 75 6e 64 | 1984. |One hund|
|00003100| 72 65 64 20 6f 66 20 74 | 68 65 20 33 33 31 20 77 |red of t|he 331 w|
|00003110| 69 74 68 0d 0a 68 65 6d | 69 70 6c 65 67 69 61 20 |ith..hem|iplegia |
|00003120| 28 33 30 25 29 2c 20 31 | 35 32 20 6f 66 20 74 68 |(30%), 1|52 of th|
|00003130| 65 20 32 33 36 20 77 69 | 74 68 20 64 69 70 6c 65 |e 236 wi|th diple|
|00003140| 67 69 61 20 28 36 34 25 | 29 2c 20 61 6e 64 20 31 |gia (64%|), and 1|
|00003150| 31 35 20 6f 66 20 74 68 | 65 20 33 36 39 20 77 69 |15 of th|e 369 wi|
|00003160| 74 68 0d 0a 71 75 61 64 | 72 69 70 6c 65 67 69 61 |th..quad|riplegia|
|00003170| 20 28 33 31 25 29 20 77 | 65 69 67 68 65 64 20 32 | (31%) w|eighed 2|
|00003180| 2c 35 30 30 20 67 20 6f | 72 20 6c 65 73 73 20 61 |,500 g o|r less a|
|00003190| 74 20 62 69 72 74 68 2e | 0d 0a 20 20 20 20 20 54 |t birth.|.. T|
|000031a0| 68 65 72 65 20 77 61 73 | 20 6e 6f 20 73 69 67 6e |here was| no sign|
|000031b0| 69 66 69 63 61 6e 74 20 | 69 6e 63 72 65 61 73 65 |ificant |increase|
|000031c0| 20 69 6e 20 74 68 65 20 | 70 72 65 76 61 6c 65 6e | in the |prevalen|
|000031d0| 63 65 20 6f 66 20 63 65 | 72 65 62 72 61 6c 20 70 |ce of ce|rebral p|
|000031e0| 61 6c 73 79 0d 0a 61 6d | 6f 6e 67 20 69 6e 66 61 |alsy..am|ong infa|
|000031f0| 6e 74 73 20 77 69 74 68 | 20 62 69 72 74 68 20 77 |nts with| birth w|
|00003200| 65 69 67 68 74 73 20 6f | 66 20 67 72 65 61 74 65 |eights o|f greate|
|00003210| 72 20 74 68 61 6e 20 32 | 2c 35 30 30 20 67 2e 20 |r than 2|,500 g. |
|00003220| 20 49 6e 20 63 6f 6e 74 | 72 61 73 74 2c 0d 0a 69 | In cont|rast,..i|
|00003230| 6e 66 61 6e 74 73 20 6f | 66 20 6c 6f 77 20 62 69 |nfants o|f low bi|
|00003240| 72 74 68 20 77 65 69 67 | 68 74 20 28 31 2c 35 30 |rth weig|ht (1,50|
|00003250| 31 2d 32 2c 35 30 30 20 | 67 29 20 68 61 64 20 61 |1-2,500 |g) had a|
|00003260| 20 74 77 6f 2d 20 74 6f | 20 74 68 72 65 65 2d 66 | two- to| three-f|
|00003270| 6f 6c 64 20 69 6e 63 72 | 65 61 73 65 0d 0a 69 6e |old incr|ease..in|
|00003280| 20 74 68 65 20 70 72 65 | 76 61 6c 65 6e 63 65 20 | the pre|valence |
|00003290| 6f 66 20 63 65 72 65 62 | 72 61 6c 20 70 61 6c 73 |of cereb|ral pals|
|000032a0| 79 20 6f 66 20 61 6c 6c | 20 6d 61 69 6e 20 63 6c |y of all| main cl|
|000032b0| 69 6e 69 63 61 6c 20 74 | 79 70 65 73 20 75 70 20 |inical t|ypes up |
|000032c0| 74 6f 0d 0a 31 39 37 37 | 2d 31 39 37 39 2c 20 66 |to..1977|-1979, f|
|000032d0| 6f 6c 6c 6f 77 65 64 20 | 62 79 20 61 20 70 6c 61 |ollowed |by a pla|
|000032e0| 74 65 61 75 20 6f 72 20 | 6d 6f 64 65 72 61 74 65 |teau or |moderate|
|000032f0| 20 64 65 63 6c 69 6e 65 | 20 74 68 65 72 65 61 66 | decline| thereaf|
|00003300| 74 65 72 2e 20 20 46 6f | 72 0d 0a 76 65 72 79 2d |ter. Fo|r..very-|
|00003310| 6c 6f 77 2d 62 69 72 74 | 68 2d 77 65 69 67 68 74 |low-birt|h-weight|
|00003320| 20 69 6e 66 61 6e 74 73 | 20 28 31 2c 35 30 30 20 | infants| (1,500 |
|00003330| 67 20 6f 72 20 6c 6f 77 | 65 72 29 20 74 68 65 20 |g or low|er) the |
|00003340| 69 6e 63 72 65 61 73 65 | 20 73 74 61 72 74 65 64 |increase| started|
|00003350| 20 6c 61 74 65 72 0d 0a | 77 69 74 68 20 61 20 66 | later..|with a f|
|00003360| 69 76 65 2d 20 74 6f 20 | 73 69 78 2d 66 6f 6c 64 |ive- to |six-fold|
|00003370| 20 69 6e 63 72 65 61 73 | 65 20 69 6e 20 74 68 65 | increas|e in the|
|00003380| 20 70 72 65 76 61 6c 65 | 6e 63 65 20 72 61 74 65 | prevale|nce rate|
|00003390| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 72 69 73 65 |... |The rise|
|000033a0| 20 69 6e 20 70 72 65 76 | 61 6c 65 6e 63 65 20 72 | in prev|alence r|
|000033b0| 61 74 65 73 20 69 6e 20 | 62 6f 74 68 20 6c 6f 77 |ates in |both low|
|000033c0| 2d 62 69 72 74 68 2d 77 | 65 69 67 68 74 20 67 72 |-birth-w|eight gr|
|000033d0| 6f 75 70 73 20 77 61 73 | 0d 0a 63 6f 6e 74 72 69 |oups was|..contri|
|000033e0| 62 75 74 65 64 20 74 6f | 20 62 79 20 61 6c 6c 20 |buted to| by all |
|000033f0| 33 20 6d 61 69 6e 20 63 | 6c 69 6e 69 63 61 6c 20 |3 main c|linical |
|00003400| 74 79 70 65 73 20 6f 66 | 20 63 65 72 65 62 72 61 |types of| cerebra|
|00003410| 6c 20 70 61 6c 73 79 2e | 20 20 54 68 65 20 69 6e |l palsy.| The in|
|00003420| 63 72 65 61 73 65 64 0d | 0a 70 72 65 76 61 6c 65 |creased.|.prevale|
|00003430| 6e 63 65 20 6f 66 20 63 | 65 72 65 62 72 61 6c 20 |nce of c|erebral |
|00003440| 70 61 6c 73 79 20 69 6e | 20 6c 6f 77 2d 62 69 72 |palsy in| low-bir|
|00003450| 74 68 2d 77 65 69 67 68 | 74 20 70 61 74 69 65 6e |th-weigh|t patien|
|00003460| 74 73 20 77 61 73 20 61 | 63 63 6f 6d 70 61 6e 69 |ts was a|ccompani|
|00003470| 65 64 20 62 79 0d 0a 61 | 6e 20 69 6e 63 72 65 61 |ed by..a|n increa|
|00003480| 73 69 6e 67 20 6e 75 6d | 62 65 72 20 77 68 6f 20 |sing num|ber who |
|00003490| 73 75 72 76 69 76 65 64 | 20 62 75 74 20 64 69 64 |survived| but did|
|000034a0| 20 6e 6f 74 20 68 61 76 | 65 20 63 65 72 65 62 72 | not hav|e cerebr|
|000034b0| 61 6c 20 70 61 6c 73 79 | 2e 0d 0a 20 20 20 20 20 |al palsy|... |
|000034c0| 54 68 65 72 65 20 69 73 | 20 61 6e 20 69 6e 63 72 |There is| an incr|
|000034d0| 65 61 73 69 6e 67 20 70 | 72 65 76 61 6c 65 6e 63 |easing p|revalenc|
|000034e0| 65 20 6f 66 20 63 65 72 | 65 62 72 61 6c 20 70 61 |e of cer|ebral pa|
|000034f0| 6c 73 79 20 61 6d 6f 6e | 67 0d 0a 6c 6f 77 2d 62 |lsy amon|g..low-b|
|00003500| 69 72 74 68 2d 77 65 69 | 67 68 74 20 69 6e 66 61 |irth-wei|ght infa|
|00003510| 6e 74 73 2e 20 20 54 68 | 65 73 65 20 63 68 61 6e |nts. Th|ese chan|
|00003520| 67 65 73 20 63 6f 75 6c | 64 20 62 65 20 74 68 65 |ges coul|d be the|
|00003530| 20 72 65 73 75 6c 74 20 | 6f 66 20 69 6d 70 72 6f | result |of impro|
|00003540| 76 65 64 0d 0a 73 75 72 | 76 69 76 61 6c 20 6f 66 |ved..sur|vival of|
|00003550| 20 70 72 65 6e 61 74 61 | 6c 6c 79 20 69 6d 70 61 | prenata|lly impa|
|00003560| 69 72 65 64 20 69 6e 66 | 61 6e 74 73 20 62 65 63 |ired inf|ants bec|
|00003570| 61 75 73 65 20 6f 66 20 | 69 6d 70 72 6f 76 65 64 |ause of |improved|
|00003580| 20 6d 65 64 69 63 61 6c | 20 63 61 72 65 2c 20 6f | medical| care, o|
|00003590| 72 20 61 0d 0a 72 65 66 | 6c 65 63 74 69 6f 6e 20 |r a..ref|lection |
|000035a0| 6f 66 20 66 61 69 6c 75 | 72 65 20 74 6f 20 6d 61 |of failu|re to ma|
|000035b0| 69 6e 74 61 69 6e 20 6f | 70 74 69 6d 61 6c 20 63 |intain o|ptimal c|
|000035c0| 6f 6e 64 69 74 69 6f 6e | 73 20 61 74 20 6f 72 20 |ondition|s at or |
|000035d0| 61 72 6f 75 6e 64 20 74 | 68 65 20 74 69 6d 65 20 |around t|he time |
|000035e0| 6f 66 0d 0a 62 69 72 74 | 68 2e 0d 0a 0d 0a 50 6f |of..birt|h.....Po|
|000035f0| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00003600| 20 20 20 44 61 74 61 20 | 66 72 6f 6d 20 4c 69 76 | Data |from Liv|
|00003610| 65 72 70 6f 6f 6c 20 63 | 61 6e 20 6e 6f 77 20 62 |erpool c|an now b|
|00003620| 65 20 61 64 64 65 64 20 | 74 6f 20 72 65 70 6f 72 |e added |to repor|
|00003630| 74 73 20 66 72 6f 6d 20 | 53 77 65 64 65 6e 2c 20 |ts from |Sweden, |
|00003640| 49 72 65 6c 61 6e 64 2c | 20 61 6e 64 0d 0a 4e 6f |Ireland,| and..No|
|00003650| 72 77 61 79 20 74 68 61 | 74 20 77 65 72 65 20 64 |rway tha|t were d|
|00003660| 65 73 63 72 69 62 65 64 | 20 69 6e 20 74 68 65 20 |escribed| in the |
|00003670| 31 39 39 30 20 59 45 41 | 52 20 42 4f 4f 4b 20 4f |1990 YEA|R BOOK O|
|00003680| 46 20 4e 45 4f 4e 41 54 | 41 4c 20 41 4e 44 20 50 |F NEONAT|AL AND P|
|00003690| 45 52 49 4e 41 54 41 4c | 0d 0a 4d 45 44 49 43 49 |ERINATAL|..MEDICI|
|000036a0| 4e 45 2e 20 20 54 68 65 | 73 65 20 72 65 70 6f 72 |NE. The|se repor|
|000036b0| 74 73 20 6e 6f 74 65 64 | 20 61 20 6d 61 72 6b 65 |ts noted| a marke|
|000036c0| 64 20 69 6e 63 72 65 61 | 73 65 20 69 6e 20 63 65 |d increa|se in ce|
|000036d0| 72 65 62 72 61 6c 20 70 | 61 6c 73 79 20 69 6e 20 |rebral p|alsy in |
|000036e0| 69 6e 66 61 6e 74 73 0d | 0a 77 65 69 67 68 69 6e |infants.|.weighin|
|000036f0| 67 20 6c 65 73 73 20 74 | 68 61 6e 20 31 2c 35 30 |g less t|han 1,50|
|00003700| 30 20 67 20 61 74 20 62 | 69 72 74 68 2e 20 20 41 |0 g at b|irth. A|
|00003710| 20 73 69 6d 69 6c 61 72 | 20 74 72 65 6e 64 20 69 | similar| trend i|
|00003720| 73 20 6f 62 73 65 72 76 | 65 64 20 69 6e 20 74 68 |s observ|ed in th|
|00003730| 69 73 0d 0a 72 65 70 6f | 72 74 2e 20 20 54 68 65 |is..repo|rt. The|
|00003740| 72 65 20 69 73 20 61 20 | 72 65 61 6c 20 63 6f 73 |re is a |real cos|
|00003750| 74 20 74 6f 20 69 6e 63 | 72 65 61 73 69 6e 67 20 |t to inc|reasing |
|00003760| 74 68 65 20 73 75 72 76 | 69 76 61 6c 20 72 61 74 |the surv|ival rat|
|00003770| 65 73 20 66 6f 72 20 73 | 6d 61 6c 6c 0d 0a 69 6e |es for s|mall..in|
|00003780| 66 61 6e 74 73 2e 20 20 | 41 20 6d 61 6a 6f 72 20 |fants. |A major |
|00003790| 71 75 65 73 74 69 6f 6e | 20 69 73 20 77 68 65 74 |question| is whet|
|000037a0| 68 65 72 20 74 68 69 73 | 20 69 6e 63 72 65 61 73 |her this| increas|
|000037b0| 65 20 69 73 20 73 65 63 | 6f 6e 64 61 72 79 20 74 |e is sec|ondary t|
|000037c0| 6f 20 69 6e 74 72 61 2d | 20 6f 72 0d 0a 65 78 74 |o intra-| or..ext|
|000037d0| 72 61 75 74 65 72 69 6e | 65 20 65 76 65 6e 74 73 |rauterin|e events|
|000037e0| 2e 2d 2d 4d 2e 48 2e 20 | 4b 6c 61 75 73 2c 20 4d |.--M.H. |Klaus, M|
|000037f0| 2e 44 2e 0d 0a 24 55 6e | 69 71 75 65 5f 49 44 7b |.D...$Un|ique_ID{|
|00003800| 59 52 42 30 32 34 30 33 | 7d 0d 0a 24 54 69 74 6c |YRB02403|}..$Titl|
|00003810| 65 7b 54 68 65 20 4c 6f | 6e 67 2d 54 65 72 6d 20 |e{The Lo|ng-Term |
|00003820| 45 66 66 65 63 74 73 20 | 6f 66 20 45 78 70 6f 73 |Effects |of Expos|
|00003830| 75 72 65 20 74 6f 20 4c | 6f 77 20 44 6f 73 65 73 |ure to L|ow Doses|
|00003840| 20 6f 66 20 4c 65 61 64 | 20 69 6e 20 43 68 69 6c | of Lead| in Chil|
|00003850| 64 68 6f 6f 64 3a 0d 0a | 41 6e 20 31 31 2d 59 65 |dhood:..|An 11-Ye|
|00003860| 61 72 20 46 6f 6c 6c 6f | 77 2d 55 70 20 52 65 70 |ar Follo|w-Up Rep|
|00003870| 6f 72 74 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 0d 0a |ort}..$A|uthor{..|
|00003880| 4e 65 65 64 6c 65 6d 61 | 6e 2c 20 48 4c 0d 0a 53 |Needlema|n, HL..S|
|00003890| 63 68 65 6c 6c 2c 20 41 | 0d 0a 42 65 6c 6c 69 6e |chell, A|..Bellin|
|000038a0| 67 65 72 2c 20 44 0d 0a | 4c 65 76 69 74 6f 6e 2c |ger, D..|Leviton,|
|000038b0| 20 41 0d 0a 41 6c 6c 72 | 65 64 2c 20 45 4e 7d 0d | A..Allr|ed, EN}.|
|000038c0| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 55 6e |.$Affili|ation{Un|
|000038d0| 69 76 20 6f 66 20 50 69 | 74 74 73 62 75 72 67 68 |iv of Pi|ttsburgh|
|000038e0| 3b 20 42 6f 73 74 6f 6e | 20 55 6e 69 76 3b 20 43 |; Boston| Univ; C|
|000038f0| 68 69 6c 64 72 65 6e 27 | 73 20 48 6f 73 70 2c 20 |hildren'|s Hosp, |
|00003900| 42 6f 73 74 6f 6e 3b 20 | 48 61 72 76 61 72 64 0d |Boston; |Harvard.|
|00003910| 0a 4d 65 64 20 53 63 68 | 6f 6f 6c 7d 0d 0a 24 4a |.Med Sch|ool}..$J|
|00003920| 6f 75 72 6e 61 6c 7b 4e | 20 45 6e 67 6c 20 4a 20 |ournal{N| Engl J |
|00003930| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 33 32 |Med}..$V|olume{32|
|00003940| 32 7d 0d 0a 24 50 61 67 | 65 7b 38 33 2d 38 38 7d |2}..$Pag|e{83-88}|
|00003950| 0d 0a 24 44 61 74 65 7b | 31 39 39 30 7d 0d 0a 24 |..$Date{|1990}..$|
|00003960| 59 42 56 6f 6c 7b 31 39 | 39 31 20 59 65 61 72 20 |YBVol{19|91 Year |
|00003970| 42 6f 6f 6b 20 6f 66 20 | 4e 65 6f 6e 61 74 61 6c |Book of |Neonatal|
|00003980| 20 61 6e 64 20 50 65 72 | 69 6e 61 74 61 6c 20 4d | and Per|inatal M|
|00003990| 65 64 69 63 69 6e 65 7d | 0d 0a 24 43 68 61 70 74 |edicine}|..$Chapt|
|000039a0| 65 72 7b 31 37 2d 31 34 | 7d 0d 0a 24 59 42 45 64 |er{17-14|}..$YBEd|
|000039b0| 69 74 6f 72 7b 44 72 73 | 2e 20 4b 6c 61 75 73 20 |itor{Drs|. Klaus |
|000039c0| 61 6e 64 20 46 61 6e 61 | 72 6f 66 66 7d 0d 0a 24 |and Fana|roff}..$|
|000039d0| 54 61 62 6c 65 7b 7d 0d | 0a 24 43 6f 6d 6d 65 6e |Table{}.|.$Commen|
|000039e0| 74 61 74 6f 72 7b 4d 2e | 48 2e 20 4b 6c 61 75 73 |tator{M.|H. Klaus|
|000039f0| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00003a00| 69 67 68 74 20 28 43 29 | 20 59 65 61 72 20 42 6f |ight (C)| Year Bo|
|00003a10| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00003a20| 73 68 65 72 73 2c 20 49 | 6e 63 2e 20 31 39 39 31 |shers, I|nc. 1991|
|00003a30| 0d 0a 0d 0a 31 39 39 31 | 20 59 65 61 72 20 42 6f |....1991| Year Bo|
|00003a40| 6f 6b 20 6f 66 20 4e 65 | 6f 6e 61 74 61 6c 20 61 |ok of Ne|onatal a|
|00003a50| 6e 64 20 50 65 72 69 6e | 61 74 61 6c 20 4d 65 64 |nd Perin|atal Med|
|00003a60| 69 63 69 6e 65 0d 0a 0d | 0a 43 68 61 70 74 65 72 |icine...|.Chapter|
|00003a70| 20 31 37 20 2d 2d 20 4f | 75 74 63 6f 6d 65 20 2d | 17 -- O|utcome -|
|00003a80| 2d 20 50 6f 73 74 6e 61 | 74 61 6c 20 47 72 6f 77 |- Postna|tal Grow|
|00003a90| 74 68 20 61 6e 64 20 44 | 65 76 65 6c 6f 70 6d 65 |th and D|evelopme|
|00003aa0| 6e 74 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |nt....--|--------|
|00003ab0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ac0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ad0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003ae0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003af0| 2d 2d 2d 2d 0d 0a 54 68 | 65 20 4c 6f 6e 67 2d 54 |----..Th|e Long-T|
|00003b00| 65 72 6d 20 45 66 66 65 | 63 74 73 20 6f 66 20 45 |erm Effe|cts of E|
|00003b10| 78 70 6f 73 75 72 65 20 | 74 6f 20 4c 6f 77 20 44 |xposure |to Low D|
|00003b20| 6f 73 65 73 20 6f 66 20 | 4c 65 61 64 20 69 6e 20 |oses of |Lead in |
|00003b30| 43 68 69 6c 64 68 6f 6f | 64 3a 20 20 41 6e 0d 0a |Childhoo|d: An..|
|00003b40| 31 31 2d 59 65 61 72 20 | 46 6f 6c 6c 6f 77 2d 55 |11-Year |Follow-U|
|00003b50| 70 20 52 65 70 6f 72 74 | 0d 0a 0d 0a 4e 65 65 64 |p Report|....Need|
|00003b60| 6c 65 6d 61 6e 20 48 4c | 3b 20 53 63 68 65 6c 6c |leman HL|; Schell|
|00003b70| 20 41 3b 20 42 65 6c 6c | 69 6e 67 65 72 20 44 3b | A; Bell|inger D;|
|00003b80| 20 4c 65 76 69 74 6f 6e | 20 41 3b 20 41 6c 6c 72 | Leviton| A; Allr|
|00003b90| 65 64 20 45 4e 0d 0a 28 | 55 6e 69 76 20 6f 66 20 |ed EN..(|Univ of |
|00003ba0| 50 69 74 74 73 62 75 72 | 67 68 3b 20 42 6f 73 74 |Pittsbur|gh; Bost|
|00003bb0| 6f 6e 20 55 6e 69 76 3b | 20 43 68 69 6c 64 72 65 |on Univ;| Childre|
|00003bc0| 6e 27 73 20 48 6f 73 70 | 2c 20 42 6f 73 74 6f 6e |n's Hosp|, Boston|
|00003bd0| 3b 20 48 61 72 76 61 72 | 64 20 4d 65 64 20 53 63 |; Harvar|d Med Sc|
|00003be0| 68 6f 6f 6c 29 0d 0a 4e | 20 45 6e 67 6c 20 4a 20 |hool)..N| Engl J |
|00003bf0| 4d 65 64 20 33 32 32 3a | 38 33 2d 38 38 2c 20 31 |Med 322:|83-88, 1|
|00003c00| 39 39 30 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |990..---|--------|
|00003c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003c50| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00003c60| 0a 0d 0a 20 20 20 20 20 | 59 6f 75 6e 67 20 63 68 |... |Young ch|
|00003c70| 69 6c 64 72 65 6e 20 77 | 69 74 68 20 69 6e 63 72 |ildren w|ith incr|
|00003c80| 65 61 73 65 64 20 6c 65 | 76 65 6c 73 20 6f 66 20 |eased le|vels of |
|00003c90| 6c 65 61 64 20 69 6e 20 | 64 65 6e 74 69 6e 20 62 |lead in |dentin b|
|00003ca0| 75 74 20 6e 6f 20 73 79 | 6d 70 74 6f 6d 73 20 6f |ut no sy|mptoms o|
|00003cb0| 66 0d 0a 70 6c 75 6d 62 | 69 73 6d 20 68 61 76 65 |f..plumb|ism have|
|00003cc0| 20 62 65 65 6e 20 66 6f | 75 6e 64 20 74 6f 20 68 | been fo|und to h|
|00003cd0| 61 76 65 20 70 73 79 63 | 68 6f 6d 65 74 72 69 63 |ave psyc|hometric|
|00003ce0| 20 64 65 66 69 63 69 74 | 73 20 61 6e 64 20 69 6d | deficit|s and im|
|00003cf0| 70 61 69 72 65 64 20 73 | 63 68 6f 6f 6c 0d 0a 70 |paired s|chool..p|
|00003d00| 65 72 66 6f 72 6d 61 6e | 63 65 2e 20 20 4f 6e 65 |erforman|ce. One|
|00003d10| 20 68 75 6e 64 72 65 64 | 20 74 68 69 72 74 79 2d | hundred| thirty-|
|00003d20| 74 77 6f 20 6f 66 20 74 | 68 65 20 32 37 30 20 69 |two of t|he 270 i|
|00003d30| 6e 69 74 69 61 6c 20 73 | 75 62 6a 65 63 74 73 20 |nitial s|ubjects |
|00003d40| 69 6e 20 31 20 73 74 75 | 64 79 0d 0a 77 65 72 65 |in 1 stu|dy..were|
|00003d50| 20 61 76 61 69 6c 61 62 | 6c 65 20 66 6f 72 20 72 | availab|le for r|
|00003d60| 65 61 73 73 65 73 73 6d | 65 6e 74 20 61 73 20 79 |eassessm|ent as y|
|00003d70| 6f 75 6e 67 20 61 64 75 | 6c 74 73 2e 20 20 54 68 |oung adu|lts. Th|
|00003d80| 6f 73 65 20 77 68 6f 20 | 77 65 72 65 20 66 6f 6c |ose who |were fol|
|00003d90| 6c 6f 77 65 64 20 75 70 | 0d 0a 68 61 64 20 68 61 |lowed up|..had ha|
|00003da0| 64 20 72 65 6c 61 74 69 | 76 65 6c 79 20 6c 6f 77 |d relati|vely low|
|00003db0| 65 72 20 6c 65 76 65 6c | 73 20 6f 66 20 6c 65 61 |er level|s of lea|
|00003dc0| 64 20 69 6e 20 64 65 6e | 74 69 6e 20 61 6e 64 20 |d in den|tin and |
|00003dd0| 68 69 67 68 65 72 20 49 | 51 20 73 63 6f 72 65 73 |higher I|Q scores|
|00003de0| 20 61 74 0d 0a 69 6e 69 | 74 69 61 6c 20 61 73 73 | at..ini|tial ass|
|00003df0| 65 73 73 6d 65 6e 74 2e | 0d 0a 20 20 20 20 20 49 |essment.|.. I|
|00003e00| 6d 70 61 69 72 65 64 20 | 6e 65 75 72 6f 62 65 68 |mpaired |neurobeh|
|00003e10| 61 76 69 6f 72 61 6c 20 | 66 75 6e 63 74 69 6f 6e |avioral |function|
|00003e20| 20 72 65 6d 61 69 6e 65 | 64 20 72 65 6c 61 74 65 | remaine|d relate|
|00003e30| 64 20 74 6f 20 74 68 65 | 20 6c 65 61 64 20 63 6f |d to the| lead co|
|00003e40| 6e 74 65 6e 74 20 6f 66 | 0d 0a 74 65 65 74 68 20 |ntent of|..teeth |
|00003e50| 73 68 65 64 20 61 74 20 | 61 67 65 73 20 36 2d 37 |shed at |ages 6-7|
|00003e60| 20 79 65 61 72 73 2e 20 | 20 53 75 62 6a 65 63 74 | years. | Subject|
|00003e70| 73 20 77 69 74 68 20 6c | 65 76 65 6c 73 20 6f 66 |s with l|evels of|
|00003e80| 20 6c 65 61 64 20 69 6e | 20 64 65 6e 74 69 6e 20 | lead in| dentin |
|00003e90| 6f 66 0d 0a 67 72 65 61 | 74 65 72 20 74 68 61 6e |of..grea|ter than|
|00003ea0| 20 32 30 20 70 70 6d 20 | 77 65 72 65 20 61 74 20 | 20 ppm |were at |
|00003eb0| 61 20 6d 75 63 68 20 68 | 69 67 68 65 72 20 72 69 |a much h|igher ri|
|00003ec0| 73 6b 20 6f 66 20 64 72 | 6f 70 70 69 6e 67 20 6f |sk of dr|opping o|
|00003ed0| 75 74 20 6f 66 20 68 69 | 67 68 20 73 63 68 6f 6f |ut of hi|gh schoo|
|00003ee0| 6c 0d 0a 61 6e 64 20 6f | 66 20 68 61 76 69 6e 67 |l..and o|f having|
|00003ef0| 20 72 65 61 64 69 6e 67 | 20 64 69 73 61 62 69 6c | reading| disabil|
|00003f00| 69 74 79 2e 20 20 48 69 | 67 68 65 72 20 6c 65 76 |ity. Hi|gher lev|
|00003f10| 65 6c 73 20 6f 66 20 6c | 65 61 64 20 69 6e 20 63 |els of l|ead in c|
|00003f20| 68 69 6c 64 68 6f 6f 64 | 20 77 65 72 65 0d 0a 61 |hildhood| were..a|
|00003f30| 73 73 6f 63 69 61 74 65 | 64 20 77 69 74 68 20 61 |ssociate|d with a|
|00003f40| 20 6c 6f 77 65 72 20 63 | 6c 61 73 73 20 73 74 61 | lower c|lass sta|
|00003f50| 6e 64 69 6e 67 20 69 6e | 20 68 69 67 68 20 73 63 |nding in| high sc|
|00003f60| 68 6f 6f 6c 2c 20 6d 6f | 72 65 20 61 62 73 65 6e |hool, mo|re absen|
|00003f70| 74 65 65 69 73 6d 2c 20 | 61 6e 64 0d 0a 6c 6f 77 |teeism, |and..low|
|00003f80| 65 72 20 76 6f 63 61 62 | 75 6c 61 72 79 20 61 6e |er vocab|ulary an|
|00003f90| 64 20 67 72 61 6d 6d 61 | 74 69 63 61 6c 20 72 65 |d gramma|tical re|
|00003fa0| 61 73 6f 6e 69 6e 67 20 | 73 63 6f 72 65 73 2e 20 |asoning |scores. |
|00003fb0| 20 49 6e 20 61 64 64 69 | 74 69 6f 6e 2c 20 68 69 | In addi|tion, hi|
|00003fc0| 67 68 65 72 20 6c 65 76 | 65 6c 73 0d 0a 6f 66 20 |gher lev|els..of |
|00003fd0| 6c 65 61 64 20 63 6f 72 | 72 65 6c 61 74 65 64 20 |lead cor|related |
|00003fe0| 77 69 74 68 20 70 6f 6f | 72 65 72 20 68 61 6e 64 |with poo|rer hand|
|00003ff0| 2d 65 79 65 20 63 6f 6f | 72 64 69 6e 61 74 69 6f |-eye coo|rdinatio|
|00004000| 6e 20 61 6e 64 20 6c 6f | 6e 67 65 72 20 72 65 61 |n and lo|nger rea|
|00004010| 63 74 69 6f 6e 0d 0a 74 | 69 6d 65 73 2e 20 20 57 |ction..t|imes. W|
|00004020| 68 65 6e 20 31 30 20 63 | 68 69 6c 64 72 65 6e 20 |hen 10 c|hildren |
|00004030| 77 69 74 68 20 63 6c 69 | 6e 69 63 61 6c 20 70 6c |with cli|nical pl|
|00004040| 75 6d 62 69 73 6d 20 77 | 65 72 65 20 69 6e 63 6c |umbism w|ere incl|
|00004050| 75 64 65 64 20 77 69 74 | 68 20 74 68 65 20 6f 74 |uded wit|h the ot|
|00004060| 68 65 72 0d 0a 73 75 62 | 6a 65 63 74 73 2c 20 61 |her..sub|jects, a|
|00004070| 20 64 6f 73 65 2d 72 65 | 73 70 6f 6e 73 65 20 72 | dose-re|sponse r|
|00004080| 65 6c 61 74 69 6f 6e 73 | 68 69 70 20 77 61 73 20 |elations|hip was |
|00004090| 65 76 69 64 65 6e 74 20 | 66 6f 72 20 62 6f 74 68 |evident |for both|
|000040a0| 20 64 72 6f 70 70 69 6e | 67 20 6f 75 74 20 6f 66 | droppin|g out of|
|000040b0| 0d 0a 73 63 68 6f 6f 6c | 20 61 6e 64 20 68 61 76 |..school| and hav|
|000040c0| 69 6e 67 20 61 20 72 65 | 61 64 69 6e 67 20 64 69 |ing a re|ading di|
|000040d0| 73 61 62 69 6c 69 74 79 | 2e 0d 0a 20 20 20 20 20 |sability|... |
|000040e0| 4c 65 61 64 20 65 78 70 | 6f 73 75 72 65 2c 20 65 |Lead exp|osure, e|
|000040f0| 76 65 6e 20 69 6e 20 63 | 68 69 6c 64 72 65 6e 20 |ven in c|hildren |
|00004100| 77 68 6f 20 72 65 6d 61 | 69 6e 20 61 73 79 6d 70 |who rema|in asymp|
|00004110| 74 6f 6d 61 74 69 63 2c | 20 63 61 6e 20 68 61 76 |tomatic,| can hav|
|00004120| 65 20 6c 61 73 74 69 6e | 67 0d 0a 65 66 66 65 63 |e lastin|g..effec|
|00004130| 74 73 20 6f 6e 20 73 75 | 63 63 65 73 73 20 69 6e |ts on su|ccess in|
|00004140| 20 73 63 68 6f 6f 6c 20 | 61 6e 64 20 69 6e 20 6c | school |and in l|
|00004150| 69 66 65 2e 20 20 42 65 | 63 61 75 73 65 20 61 73 |ife. Be|cause as|
|00004160| 20 6d 61 6e 79 20 61 73 | 20 31 36 25 20 6f 66 20 | many as| 16% of |
|00004170| 63 68 69 6c 64 72 65 6e | 0d 0a 69 6e 20 74 68 65 |children|..in the|
|00004180| 20 55 6e 69 74 65 64 20 | 53 74 61 74 65 73 20 68 | United |States h|
|00004190| 61 76 65 20 69 6e 63 72 | 65 61 73 65 64 20 62 6c |ave incr|eased bl|
|000041a0| 6f 6f 64 20 6c 65 76 65 | 6c 73 20 6f 66 20 6c 65 |ood leve|ls of le|
|000041b0| 61 64 2c 20 74 68 65 20 | 69 6d 70 6c 69 63 61 74 |ad, the |implicat|
|000041c0| 69 6f 6e 73 20 66 6f 72 | 0d 0a 70 72 65 76 65 6e |ions for|..preven|
|000041d0| 74 69 6e 67 20 73 63 68 | 6f 6f 6c 20 66 61 69 6c |ting sch|ool fail|
|000041e0| 75 72 65 20 61 72 65 20 | 6f 66 20 67 72 65 61 74 |ure are |of great|
|000041f0| 20 69 6e 74 65 72 65 73 | 74 2e 0d 0a 0d 0a 50 6f | interes|t.....Po|
|00004200| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00004210| 20 20 20 49 74 20 69 73 | 20 69 6e 74 65 72 65 73 | It is| interes|
|00004220| 74 69 6e 67 20 68 6f 77 | 20 74 68 65 20 22 73 61 |ting how| the "sa|
|00004230| 66 65 22 20 62 6c 6f 6f | 64 20 6c 65 61 64 20 6c |fe" bloo|d lead l|
|00004240| 65 76 65 6c 20 6b 65 65 | 70 73 20 64 72 6f 70 70 |evel kee|ps dropp|
|00004250| 69 6e 67 20 65 76 65 72 | 79 0d 0a 35 2d 31 30 20 |ing ever|y..5-10 |
|00004260| 79 65 61 72 73 2e 20 20 | 54 68 65 20 75 6e 69 71 |years. |The uniq|
|00004270| 75 65 20 66 65 61 74 75 | 72 65 73 20 6f 66 20 74 |ue featu|res of t|
|00004280| 68 69 73 20 73 74 75 64 | 79 20 61 72 65 20 74 68 |his stud|y are th|
|00004290| 65 20 76 65 72 79 20 6c | 6f 6e 67 20 66 6f 6c 6c |e very l|ong foll|
|000042a0| 6f 77 2d 75 70 20 28 31 | 31 0d 0a 79 65 61 72 73 |ow-up (1|1..years|
|000042b0| 29 20 61 6e 64 20 74 68 | 65 20 75 70 73 65 74 74 |) and th|e upsett|
|000042c0| 69 6e 67 20 66 69 6e 64 | 69 6e 67 73 2e 20 20 41 |ing find|ings. A|
|000042d0| 73 20 77 65 20 61 74 74 | 65 6d 70 74 20 74 6f 20 |s we att|empt to |
|000042e0| 63 6c 65 61 6e 20 6f 75 | 72 20 65 6e 76 69 72 6f |clean ou|r enviro|
|000042f0| 6e 6d 65 6e 74 2c 0d 0a | 68 65 61 76 79 20 6d 65 |nment,..|heavy me|
|00004300| 74 61 6c 20 70 6f 69 73 | 6f 6e 69 6e 67 20 63 6f |tal pois|oning co|
|00004310| 6e 74 69 6e 75 65 73 20 | 74 6f 20 62 65 20 61 20 |ntinues |to be a |
|00004320| 6d 61 6a 6f 72 20 70 72 | 6f 62 6c 65 6d 20 66 6f |major pr|oblem fo|
|00004330| 72 20 79 6f 75 6e 67 20 | 69 6e 66 61 6e 74 73 20 |r young |infants |
|00004340| 61 6e 64 0d 0a 63 68 69 | 6c 64 72 65 6e 2e 2d 2d |and..chi|ldren.--|
|00004350| 4d 2e 48 2e 20 4b 6c 61 | 75 73 2c 20 4d 2e 44 2e |M.H. Kla|us, M.D.|
|00004360| 0d 0a 24 55 6e 69 71 75 | 65 5f 49 44 7b 59 52 42 |..$Uniqu|e_ID{YRB|
|00004370| 30 32 34 30 34 7d 0d 0a | 24 54 69 74 6c 65 7b 43 |02404}..|$Title{C|
|00004380| 6c 69 6e 69 63 61 6c 20 | 4d 61 6e 61 67 65 6d 65 |linical |Manageme|
|00004390| 6e 74 20 43 6f 6e 73 69 | 64 65 72 61 74 69 6f 6e |nt Consi|deration|
|000043a0| 73 20 69 6e 20 4c 6f 6e | 67 2d 54 65 72 6d 20 53 |s in Lon|g-Term S|
|000043b0| 75 72 76 69 76 6f 72 73 | 20 57 69 74 68 20 54 72 |urvivors| With Tr|
|000043c0| 69 73 6f 6d 79 0d 0a 31 | 38 7d 0d 0a 24 41 75 74 |isomy..1|8}..$Aut|
|000043d0| 68 6f 72 7b 0d 0a 56 61 | 6e 20 44 79 6b 65 2c 20 |hor{..Va|n Dyke, |
|000043e0| 44 43 0d 0a 41 6c 6c 65 | 6e 2c 20 4d 7d 0d 0a 24 |DC..Alle|n, M}..$|
|000043f0| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 55 6e 69 76 |Affiliat|ion{Univ|
|00004400| 20 6f 66 20 49 6f 77 61 | 7d 0d 0a 24 4a 6f 75 72 | of Iowa|}..$Jour|
|00004410| 6e 61 6c 7b 50 65 64 69 | 61 74 72 69 63 73 7d 0d |nal{Pedi|atrics}.|
|00004420| 0a 24 56 6f 6c 75 6d 65 | 7b 38 35 7d 0d 0a 24 50 |.$Volume|{85}..$P|
|00004430| 61 67 65 7b 37 35 33 2d | 37 35 39 7d 0d 0a 24 44 |age{753-|759}..$D|
|00004440| 61 74 65 7b 31 39 39 30 | 7d 0d 0a 24 59 42 56 6f |ate{1990|}..$YBVo|
|00004450| 6c 7b 31 39 39 31 20 59 | 65 61 72 20 42 6f 6f 6b |l{1991 Y|ear Book|
|00004460| 20 6f 66 20 4e 65 6f 6e | 61 74 61 6c 20 61 6e 64 | of Neon|atal and|
|00004470| 20 50 65 72 69 6e 61 74 | 61 6c 20 4d 65 64 69 63 | Perinat|al Medic|
|00004480| 69 6e 65 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 31 |ine}..$C|hapter{1|
|00004490| 37 2d 31 35 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |7-15}..$|YBEditor|
|000044a0| 7b 44 72 73 2e 20 4b 6c | 61 75 73 20 61 6e 64 20 |{Drs. Kl|aus and |
|000044b0| 46 61 6e 61 72 6f 66 66 | 7d 0d 0a 24 54 61 62 6c |Fanaroff|}..$Tabl|
|000044c0| 65 7b 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |e{}..$Co|mmentato|
|000044d0| 72 7b 4d 2e 48 2e 20 4b | 6c 61 75 73 2c 20 4d 2e |r{M.H. K|laus, M.|
|000044e0| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|000044f0| 20 28 43 29 20 59 65 61 | 72 20 42 6f 6f 6b 20 4d | (C) Yea|r Book M|
|00004500| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00004510| 73 2c 20 49 6e 63 2e 20 | 31 39 39 31 0d 0a 0d 0a |s, Inc. |1991....|
|00004520| 31 39 39 31 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1991 Yea|r Book o|
|00004530| 66 20 4e 65 6f 6e 61 74 | 61 6c 20 61 6e 64 20 50 |f Neonat|al and P|
|00004540| 65 72 69 6e 61 74 61 6c | 20 4d 65 64 69 63 69 6e |erinatal| Medicin|
|00004550| 65 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 31 37 20 |e....Cha|pter 17 |
|00004560| 2d 2d 20 4f 75 74 63 6f | 6d 65 20 2d 2d 20 50 6f |-- Outco|me -- Po|
|00004570| 73 74 6e 61 74 61 6c 20 | 47 72 6f 77 74 68 20 61 |stnatal |Growth a|
|00004580| 6e 64 20 44 65 76 65 6c | 6f 70 6d 65 6e 74 0d 0a |nd Devel|opment..|
|00004590| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|000045a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045e0| 0d 0a 43 6c 69 6e 69 63 | 61 6c 20 4d 61 6e 61 67 |..Clinic|al Manag|
|000045f0| 65 6d 65 6e 74 20 43 6f | 6e 73 69 64 65 72 61 74 |ement Co|nsiderat|
|00004600| 69 6f 6e 73 20 69 6e 20 | 4c 6f 6e 67 2d 54 65 72 |ions in |Long-Ter|
|00004610| 6d 20 53 75 72 76 69 76 | 6f 72 73 20 57 69 74 68 |m Surviv|ors With|
|00004620| 20 54 72 69 73 6f 6d 79 | 20 31 38 0d 0a 0d 0a 56 | Trisomy| 18....V|
|00004630| 61 6e 20 44 79 6b 65 20 | 44 43 3b 20 41 6c 6c 65 |an Dyke |DC; Alle|
|00004640| 6e 20 4d 0d 0a 28 55 6e | 69 76 20 6f 66 20 49 6f |n M..(Un|iv of Io|
|00004650| 77 61 29 0d 0a 50 65 64 | 69 61 74 72 69 63 73 20 |wa)..Ped|iatrics |
|00004660| 38 35 3a 37 35 33 2d 37 | 35 39 2c 20 31 39 39 30 |85:753-7|59, 1990|
|00004670| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00004680| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004690| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046c0| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|000046d0| 20 20 20 20 20 54 72 69 | 73 6f 6d 79 20 31 38 20 | Tri|somy 18 |
|000046e0| 69 73 20 74 68 65 20 73 | 65 63 6f 6e 64 20 6d 6f |is the s|econd mo|
|000046f0| 73 74 20 63 6f 6d 6d 6f | 6e 20 74 72 69 73 6f 6d |st commo|n trisom|
|00004700| 79 2c 20 77 69 74 68 20 | 61 6e 20 69 6e 63 69 64 |y, with |an incid|
|00004710| 65 6e 63 65 20 6f 66 0d | 0a 61 70 70 72 6f 78 69 |ence of.|.approxi|
|00004720| 6d 61 74 65 6c 79 20 31 | 20 69 6e 20 38 2c 30 30 |mately 1| in 8,00|
|00004730| 30 20 62 69 72 74 68 73 | 2e 20 20 41 73 20 6d 61 |0 births|. As ma|
|00004740| 6e 79 20 61 73 20 39 30 | 25 20 6f 72 20 6d 6f 72 |ny as 90|% or mor|
|00004750| 65 20 6f 66 20 63 68 69 | 6c 64 72 65 6e 20 77 69 |e of chi|ldren wi|
|00004760| 74 68 0d 0a 74 72 69 73 | 6f 6d 79 20 31 38 20 64 |th..tris|omy 18 d|
|00004770| 69 65 20 77 69 74 68 69 | 6e 20 74 68 65 20 66 69 |ie withi|n the fi|
|00004780| 72 73 74 20 79 65 61 72 | 20 6f 66 20 6c 69 66 65 |rst year| of life|
|00004790| 2e 20 20 54 6f 20 70 72 | 6f 76 69 64 65 20 6d 6f |. To pr|ovide mo|
|000047a0| 72 65 20 69 6e 66 6f 72 | 6d 61 74 69 6f 6e 20 6f |re infor|mation o|
|000047b0| 6e 0d 0a 74 68 65 20 75 | 6e 69 71 75 65 20 61 73 |n..the u|nique as|
|000047c0| 70 65 63 74 73 20 6f 66 | 20 6d 61 6e 61 67 65 6d |pects of| managem|
|000047d0| 65 6e 74 20 6f 66 20 74 | 68 6f 73 65 20 63 68 69 |ent of t|hose chi|
|000047e0| 6c 64 72 65 6e 20 77 68 | 6f 20 73 75 72 76 69 76 |ldren wh|o surviv|
|000047f0| 65 2c 20 61 20 72 65 76 | 69 65 77 20 6f 66 0d 0a |e, a rev|iew of..|
|00004800| 74 68 65 20 72 65 63 6f | 72 64 73 20 6f 66 20 36 |the reco|rds of 6|
|00004810| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 74 | patient|s with t|
|00004820| 72 69 73 6f 6d 79 20 31 | 38 20 77 68 6f 20 73 75 |risomy 1|8 who su|
|00004830| 72 76 69 76 65 64 20 70 | 61 73 74 20 74 68 65 20 |rvived p|ast the |
|00004840| 61 67 65 20 6f 66 20 31 | 20 79 65 61 72 0d 0a 61 |age of 1| year..a|
|00004850| 6e 64 20 6f 66 20 74 68 | 65 20 74 72 69 73 6f 6d |nd of th|e trisom|
|00004860| 79 20 31 38 20 66 69 6c | 65 73 20 6f 66 20 74 68 |y 18 fil|es of th|
|00004870| 65 20 53 75 70 70 6f 72 | 74 20 4f 72 67 61 6e 69 |e Suppor|t Organi|
|00004880| 7a 61 74 69 6f 6e 20 66 | 6f 72 20 54 72 69 73 6f |zation f|or Triso|
|00004890| 6d 79 20 31 38 20 61 6e | 64 20 31 33 0d 0a 77 61 |my 18 an|d 13..wa|
|000048a0| 73 20 75 6e 64 65 72 74 | 61 6b 65 6e 2e 0d 0a 20 |s undert|aken... |
|000048b0| 20 20 20 20 4f 66 20 74 | 68 65 20 33 32 31 20 63 | Of t|he 321 c|
|000048c0| 68 69 6c 64 72 65 6e 20 | 77 69 74 68 20 74 72 69 |hildren |with tri|
|000048d0| 73 6f 6d 79 20 31 38 20 | 72 65 63 6f 72 64 65 64 |somy 18 |recorded|
|000048e0| 20 69 6e 20 74 68 65 20 | 66 69 6c 65 73 2c 20 31 | in the |files, 1|
|000048f0| 32 34 20 73 75 72 76 69 | 76 65 64 0d 0a 62 65 79 |24 survi|ved..bey|
|00004900| 6f 6e 64 20 61 67 65 20 | 31 20 79 65 61 72 2c 20 |ond age |1 year, |
|00004910| 61 6e 64 20 73 6f 6d 65 | 20 73 75 72 76 69 76 65 |and some| survive|
|00004920| 64 20 74 6f 20 61 67 65 | 73 20 32 32 2c 20 32 33 |d to age|s 22, 23|
|00004930| 2c 20 61 6e 64 20 33 35 | 20 79 65 61 72 73 2e 20 |, and 35| years. |
|00004940| 20 47 69 72 6c 73 0d 0a | 73 75 72 76 69 76 65 20 | Girls..|survive |
|00004950| 6d 6f 72 65 20 66 72 65 | 71 75 65 6e 74 6c 79 20 |more fre|quently |
|00004960| 74 68 61 6e 20 62 6f 79 | 73 2e 20 20 49 6e 20 61 |than boy|s. In a|
|00004970| 64 64 69 74 69 6f 6e 20 | 74 6f 20 74 68 65 20 6d |ddition |to the m|
|00004980| 65 64 69 63 61 6c 20 70 | 72 6f 62 6c 65 6d 73 20 |edical p|roblems |
|00004990| 74 68 61 74 0d 0a 61 72 | 65 20 75 6e 69 71 75 65 |that..ar|e unique|
|000049a0| 20 74 6f 20 74 68 65 20 | 73 79 6e 64 72 6f 6d 65 | to the |syndrome|
|000049b0| 2c 20 74 68 65 73 65 20 | 70 61 74 69 65 6e 74 73 |, these |patients|
|000049c0| 20 70 72 65 73 65 6e 74 | 20 63 6f 6d 70 6c 65 78 | present| complex|
|000049d0| 20 6d 65 64 69 63 61 6c | 20 70 72 6f 62 6c 65 6d | medical| problem|
|000049e0| 73 0d 0a 63 6f 6d 6d 6f | 6e 20 74 6f 20 61 6c 6c |s..commo|n to all|
|000049f0| 20 70 65 72 73 6f 6e 73 | 20 77 69 74 68 20 63 68 | persons| with ch|
|00004a00| 72 6f 6d 6f 73 6f 6d 61 | 6c 20 61 62 6e 6f 72 6d |romosoma|l abnorm|
|00004a10| 61 6c 69 74 69 65 73 2e | 20 20 43 6f 6e 67 65 6e |alities.| Congen|
|00004a20| 69 74 61 6c 20 68 65 61 | 72 74 0d 0a 64 69 73 65 |ital hea|rt..dise|
|00004a30| 61 73 65 2c 20 69 6e 63 | 6c 75 64 69 6e 67 20 73 |ase, inc|luding s|
|00004a40| 65 70 74 61 6c 20 64 65 | 66 65 63 74 73 20 77 69 |eptal de|fects wi|
|00004a50| 74 68 20 76 65 6e 74 72 | 69 63 75 6c 61 72 20 73 |th ventr|icular s|
|00004a60| 65 70 74 61 6c 20 64 65 | 66 65 63 74 73 2c 20 69 |eptal de|fects, i|
|00004a70| 73 20 63 6f 6d 6d 6f 6e | 2c 0d 0a 61 6e 64 20 63 |s common|,..and c|
|00004a80| 68 69 6c 64 72 65 6e 20 | 77 68 6f 20 73 75 72 76 |hildren |who surv|
|00004a90| 69 76 65 20 6c 6f 6e 67 | 65 72 20 68 61 76 65 20 |ive long|er have |
|00004aa0| 61 20 73 65 63 6f 6e 64 | 20 70 72 6f 74 65 63 74 |a second| protect|
|00004ab0| 69 76 65 20 6c 65 73 69 | 6f 6e 20 28 65 2e 67 2e |ive lesi|on (e.g.|
|00004ac0| 2c 0d 0a 70 75 6c 6d 6f | 6e 69 63 20 73 74 65 6e |,..pulmo|nic sten|
|00004ad0| 6f 73 69 73 29 2e 20 20 | 43 61 72 64 69 61 63 20 |osis). |Cardiac |
|00004ae0| 6d 61 6e 61 67 65 6d 65 | 6e 74 20 69 73 20 70 72 |manageme|nt is pr|
|00004af0| 69 6d 61 72 69 6c 79 20 | 6d 65 64 69 63 61 6c 2e |imarily |medical.|
|00004b00| 20 20 48 65 6d 69 76 65 | 72 74 65 62 72 61 65 0d | Hemive|rtebrae.|
|00004b10| 0a 69 73 20 61 20 63 6f | 6d 6d 6f 6e 20 66 69 6e |.is a co|mmon fin|
|00004b20| 64 69 6e 67 20 69 6e 20 | 74 68 65 73 65 20 63 68 |ding in |these ch|
|00004b30| 69 6c 64 72 65 6e 2c 20 | 77 69 74 68 20 73 63 6f |ildren, |with sco|
|00004b40| 6c 69 6f 73 69 73 20 62 | 65 63 6f 6d 69 6e 67 20 |liosis b|ecoming |
|00004b50| 61 70 70 61 72 65 6e 74 | 20 62 79 20 61 67 65 0d |apparent| by age.|
|00004b60| 0a 33 2d 36 20 6d 6f 6e | 74 68 73 2e 20 20 50 6f |.3-6 mon|ths. Po|
|00004b70| 73 69 74 69 6f 6e 69 6e | 67 2c 20 75 73 69 6e 67 |sitionin|g, using|
|00004b80| 20 61 6e 20 69 6e 73 65 | 72 74 20 77 68 69 6c 65 | an inse|rt while|
|00004b90| 20 73 65 61 74 65 64 2c | 20 69 73 20 74 68 65 20 | seated,| is the |
|00004ba0| 6d 6f 73 74 20 61 63 63 | 65 70 74 61 62 6c 65 0d |most acc|eptable.|
|00004bb0| 0a 66 6f 72 6d 20 6f 66 | 20 6d 6f 64 69 66 79 69 |.form of| modifyi|
|00004bc0| 6e 67 20 74 68 65 20 73 | 63 6f 6c 69 6f 73 69 73 |ng the s|coliosis|
|00004bd0| 2e 20 20 49 6e 66 65 63 | 74 69 6f 6e 20 69 73 20 |. Infec|tion is |
|00004be0| 61 6e 20 6f 6e 67 6f 69 | 6e 67 20 63 6f 6e 63 65 |an ongoi|ng conce|
|00004bf0| 72 6e 2c 20 77 69 74 68 | 0d 0a 70 6e 65 75 6d 6f |rn, with|..pneumo|
|00004c00| 6e 69 61 20 62 65 69 6e | 67 20 74 68 65 20 63 61 |nia bein|g the ca|
|00004c10| 75 73 65 20 6f 66 20 64 | 65 61 74 68 20 69 6e 20 |use of d|eath in |
|00004c20| 33 20 6f 66 20 36 20 63 | 61 73 65 20 70 61 74 69 |3 of 6 c|ase pati|
|00004c30| 65 6e 74 73 20 73 74 75 | 64 69 65 64 2e 20 20 46 |ents stu|died. F|
|00004c40| 65 65 64 69 6e 67 0d 0a | 70 72 6f 62 6c 65 6d 73 |eeding..|problems|
|00004c50| 20 61 72 65 20 61 20 6d | 61 6a 6f 72 20 6d 61 6e | are a m|ajor man|
|00004c60| 61 67 65 6d 65 6e 74 20 | 69 73 73 75 65 2c 20 61 |agement |issue, a|
|00004c70| 6e 64 20 6d 6f 73 74 20 | 6e 65 65 64 20 6e 61 73 |nd most |need nas|
|00004c80| 6f 67 61 73 74 72 69 63 | 2f 20 67 61 73 74 72 6f |ogastric|/ gastro|
|00004c90| 73 74 6f 6d 79 0d 0a 73 | 75 70 70 6c 65 6d 65 6e |stomy..s|upplemen|
|00004ca0| 74 61 74 69 6f 6e 2c 20 | 61 6c 74 68 6f 75 67 68 |tation, |although|
|00004cb0| 20 73 6f 6d 65 20 70 61 | 74 69 65 6e 74 73 20 6d | some pa|tients m|
|00004cc0| 61 79 20 67 6f 20 6f 6e | 20 74 6f 20 6f 72 61 6c |ay go on| to oral|
|00004cd0| 20 66 65 65 64 69 6e 67 | 2e 20 20 47 72 6f 77 74 | feeding|. Growt|
|00004ce0| 68 20 69 6e 0d 0a 61 6c | 6c 20 70 61 72 61 6d 65 |h in..al|l parame|
|00004cf0| 74 65 72 73 20 69 73 20 | 61 6c 77 61 79 73 20 6d |ters is |always m|
|00004d00| 61 72 6b 65 64 6c 79 20 | 6c 65 73 73 20 74 68 61 |arkedly |less tha|
|00004d10| 6e 20 74 68 65 20 66 69 | 66 74 68 20 70 65 72 63 |n the fi|fth perc|
|00004d20| 65 6e 74 69 6c 65 20 64 | 65 73 70 69 74 65 20 61 |entile d|espite a|
|00004d30| 0d 0a 68 69 67 68 20 63 | 61 6c 6f 72 69 63 20 69 |..high c|aloric i|
|00004d40| 6e 74 61 6b 65 2e 0d 0a | 20 20 20 20 20 4d 61 6e |ntake...| Man|
|00004d50| 61 67 65 6d 65 6e 74 20 | 64 6f 65 73 20 6e 6f 74 |agement |does not|
|00004d60| 20 69 6e 63 6c 75 64 65 | 20 74 68 65 20 63 68 69 | include| the chi|
|00004d70| 6c 64 20 61 6c 6f 6e 65 | 20 62 75 74 20 61 6c 73 |ld alone| but als|
|00004d80| 6f 20 74 68 65 20 66 61 | 6d 69 6c 79 20 75 6e 69 |o the fa|mily uni|
|00004d90| 74 2e 0d 0a 42 65 63 61 | 75 73 65 20 74 68 65 20 |t...Beca|use the |
|00004da0| 70 72 65 73 65 6e 63 65 | 20 6f 66 20 61 20 64 69 |presence| of a di|
|00004db0| 73 61 62 6c 65 64 20 63 | 68 69 6c 64 20 69 6e 20 |sabled c|hild in |
|00004dc0| 61 6e 79 20 66 61 6d 69 | 6c 79 20 68 61 73 20 62 |any fami|ly has b|
|00004dd0| 65 65 6e 20 6c 69 6e 6b | 65 64 20 74 6f 0d 0a 6d |een link|ed to..m|
|00004de0| 61 6a 6f 72 20 66 61 6d | 69 6c 79 20 73 74 72 65 |ajor fam|ily stre|
|00004df0| 73 73 6f 72 73 2c 20 74 | 68 65 20 66 61 6d 69 6c |ssors, t|he famil|
|00004e00| 79 20 75 6e 69 74 20 6e | 65 65 64 73 20 65 71 75 |y unit n|eeds equ|
|00004e10| 61 6c 6c 79 20 63 68 61 | 6c 6c 65 6e 67 69 6e 67 |ally cha|llenging|
|00004e20| 20 63 61 72 65 20 61 6e | 64 0d 0a 73 75 70 70 6f | care an|d..suppo|
|00004e30| 72 74 2e 20 20 54 68 65 | 73 65 20 66 61 6d 69 6c |rt. The|se famil|
|00004e40| 69 65 73 20 65 78 70 65 | 72 69 65 6e 63 65 20 61 |ies expe|rience a|
|00004e50| 20 63 6f 6d 70 6c 65 78 | 20 67 72 69 65 76 69 6e | complex| grievin|
|00004e60| 67 20 70 72 6f 63 65 73 | 73 20 74 68 61 74 20 63 |g proces|s that c|
|00004e70| 6f 6d 62 69 6e 65 73 0d | 0a 62 6f 74 68 20 74 68 |ombines.|.both th|
|00004e80| 65 20 72 65 61 63 74 69 | 76 65 20 67 72 69 65 66 |e reacti|ve grief|
|00004e90| 20 70 72 65 64 6f 6d 69 | 6e 61 6e 74 20 69 6e 20 | predomi|nant in |
|00004ea0| 63 68 72 6f 6e 69 63 20 | 69 6c 6c 6e 65 73 73 20 |chronic |illness |
|00004eb0| 61 6e 64 20 74 68 65 20 | 70 72 65 70 61 72 61 74 |and the |preparat|
|00004ec0| 6f 72 79 0d 0a 67 72 69 | 65 66 20 61 73 73 6f 63 |ory..gri|ef assoc|
|00004ed0| 69 61 74 65 64 20 77 69 | 74 68 20 69 6d 70 65 6e |iated wi|th impen|
|00004ee0| 64 69 6e 67 20 64 65 61 | 74 68 2e 20 20 42 79 20 |ding dea|th. By |
|00004ef0| 6b 6e 6f 77 69 6e 67 20 | 74 68 65 20 75 6e 69 71 |knowing |the uniq|
|00004f00| 75 65 20 62 75 74 20 63 | 6f 6d 70 6c 65 78 0d 0a |ue but c|omplex..|
|00004f10| 6d 65 64 69 63 61 6c 20 | 70 72 6f 62 6c 65 6d 73 |medical |problems|
|00004f20| 20 69 6e 20 6c 6f 6e 67 | 2d 74 65 72 6d 20 73 75 | in long|-term su|
|00004f30| 72 76 69 76 6f 72 73 20 | 77 69 74 68 20 74 72 69 |rvivors |with tri|
|00004f40| 73 6f 6d 79 20 31 38 2c | 20 61 73 20 77 65 6c 6c |somy 18,| as well|
|00004f50| 20 61 73 20 6f 66 66 65 | 72 69 6e 67 0d 0a 73 75 | as offe|ring..su|
|00004f60| 70 70 6f 72 74 69 76 65 | 20 63 61 72 65 20 74 6f |pportive| care to|
|00004f70| 20 74 68 65 20 66 61 6d | 69 6c 79 2c 20 74 68 65 | the fam|ily, the|
|00004f80| 20 70 68 79 73 69 63 69 | 61 6e 20 63 61 6e 20 70 | physici|an can p|
|00004f90| 72 6f 76 69 64 65 20 61 | 20 73 65 72 76 69 63 65 |rovide a| service|
|00004fa0| 20 6f 66 0d 0a 73 69 67 | 6e 69 66 69 63 61 6e 74 | of..sig|nificant|
|00004fb0| 20 62 65 6e 65 66 69 74 | 2e 0d 0a 0d 0a 50 6f 73 | benefit|.....Pos|
|00004fc0| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00004fd0| 20 20 4d 61 6e 79 20 70 | 68 79 73 69 63 69 61 6e | Many p|hysician|
|00004fe0| 73 20 62 65 6c 69 65 76 | 65 20 74 68 61 74 20 74 |s believ|e that t|
|00004ff0| 68 65 79 20 63 61 6e 20 | 62 65 20 6f 66 20 6c 69 |hey can |be of li|
|00005000| 74 74 6c 65 20 68 65 6c | 70 20 74 6f 20 70 61 72 |ttle hel|p to par|
|00005010| 65 6e 74 73 20 77 68 65 | 6e 0d 0a 74 68 65 20 69 |ents whe|n..the i|
|00005020| 6e 66 61 6e 74 27 73 20 | 63 6f 6e 64 69 74 69 6f |nfant's |conditio|
|00005030| 6e 20 69 73 20 75 6e 69 | 66 6f 72 6d 6c 79 20 66 |n is uni|formly f|
|00005040| 61 74 61 6c 2e 20 20 42 | 69 72 74 68 20 6f 66 20 |atal. B|irth of |
|00005050| 61 20 74 72 69 73 6f 6d | 79 20 31 38 20 69 6e 66 |a trisom|y 18 inf|
|00005060| 61 6e 74 20 69 73 20 61 | 0d 0a 6d 61 6a 6f 72 20 |ant is a|..major |
|00005070| 61 74 74 61 63 6b 20 6f | 6e 20 74 68 65 20 69 6e |attack o|n the in|
|00005080| 74 65 67 72 61 74 65 64 | 20 22 73 65 6c 66 22 20 |tegrated| "self" |
|00005090| 6f 66 20 62 6f 74 68 20 | 70 61 72 65 6e 74 73 20 |of both |parents |
|000050a0| 61 6e 64 20 72 65 71 75 | 69 72 65 73 20 74 68 61 |and requ|ires tha|
|000050b0| 74 20 74 68 65 79 0d 0a | 6d 61 6b 65 20 61 20 64 |t they..|make a d|
|000050c0| 69 66 66 69 63 75 6c 74 | 20 73 65 74 20 6f 66 20 |ifficult| set of |
|000050d0| 63 6f 6d 70 6c 65 78 20 | 61 64 6a 75 73 74 6d 65 |complex |adjustme|
|000050e0| 6e 74 73 2e 20 20 57 68 | 65 6e 20 61 20 70 68 79 |nts. Wh|en a phy|
|000050f0| 73 69 63 69 61 6e 20 6f | 72 20 63 61 72 65 74 61 |sician o|r careta|
|00005100| 6b 65 72 0d 0a 73 70 65 | 6e 64 73 20 74 69 6d 65 |ker..spe|nds time|
|00005110| 20 68 65 6c 70 69 6e 67 | 20 70 61 72 65 6e 74 73 | helping| parents|
|00005120| 20 61 64 6a 75 73 74 20 | 61 6e 64 20 63 61 72 65 | adjust |and care|
|00005130| 20 66 6f 72 20 74 68 65 | 69 72 20 73 69 63 6b 20 | for the|ir sick |
|00005140| 69 6e 66 61 6e 74 2c 20 | 68 65 20 69 73 0d 0a 73 |infant, |he is..s|
|00005150| 61 79 69 6e 67 20 77 69 | 74 68 6f 75 74 20 77 6f |aying wi|thout wo|
|00005160| 72 64 73 2c 20 22 45 76 | 65 6e 20 74 68 6f 75 67 |rds, "Ev|en thoug|
|00005170| 68 20 79 6f 75 20 68 61 | 76 65 20 68 61 64 20 61 |h you ha|ve had a|
|00005180| 20 6d 61 6c 66 6f 72 6d | 65 64 20 62 61 62 79 20 | malform|ed baby |
|00005190| 74 68 61 74 20 49 20 63 | 61 6e 6e 6f 74 0d 0a 72 |that I c|annot..r|
|000051a0| 65 70 61 69 72 2c 20 49 | 20 63 61 72 65 20 64 65 |epair, I| care de|
|000051b0| 65 70 6c 79 20 61 62 6f | 75 74 20 79 6f 75 20 61 |eply abo|ut you a|
|000051c0| 6e 64 20 79 6f 75 72 20 | 66 61 6d 69 6c 79 2e 22 |nd your |family."|
|000051d0| 20 20 54 68 69 73 20 73 | 65 6e 73 69 74 69 76 65 | This s|ensitive|
|000051e0| 20 72 65 70 6f 72 74 0d | 0a 73 68 6f 75 6c 64 20 | report.|.should |
|000051f0| 62 65 20 72 65 61 64 20 | 62 79 20 61 6c 6c 20 63 |be read |by all c|
|00005200| 61 72 65 67 69 76 65 72 | 73 20 77 6f 72 6b 69 6e |aregiver|s workin|
|00005210| 67 20 69 6e 20 74 68 65 | 20 70 65 72 69 6e 61 74 |g in the| perinat|
|00005220| 61 6c 20 70 65 72 69 6f | 64 20 77 68 6f 20 6d 61 |al perio|d who ma|
|00005230| 6e 61 67 65 0d 0a 74 68 | 6f 73 65 20 69 6e 66 61 |nage..th|ose infa|
|00005240| 6e 74 73 20 77 68 6f 20 | 61 72 65 20 6e 6f 74 20 |nts who |are not |
|00005250| 70 65 72 66 65 63 74 2e | 20 20 41 73 20 65 6d 70 |perfect.| As emp|
|00005260| 68 61 73 69 7a 65 64 20 | 62 79 20 74 68 65 20 61 |hasized |by the a|
|00005270| 75 74 68 6f 72 73 2c 20 | 22 2e 20 2e 20 2e 20 74 |uthors, |". . . t|
|00005280| 68 65 0d 0a 62 65 6e 65 | 66 69 74 73 20 74 6f 20 |he..bene|fits to |
|00005290| 62 65 20 67 61 69 6e 65 | 64 20 66 72 6f 6d 20 69 |be gaine|d from i|
|000052a0| 6e 66 6f 72 6d 65 64 2c | 20 65 6d 70 61 74 68 69 |nformed,| empathi|
|000052b0| 63 20 63 61 72 65 20 61 | 72 65 20 73 69 67 6e 69 |c care a|re signi|
|000052c0| 66 69 63 61 6e 74 22 20 | 61 6e 64 20 73 68 6f 75 |ficant" |and shou|
|000052d0| 6c 64 0d 0a 6e 65 76 65 | 72 20 62 65 20 75 6e 64 |ld..neve|r be und|
|000052e0| 65 72 65 73 74 69 6d 61 | 74 65 64 2e 2d 2d 4d 2e |erestima|ted.--M.|
|000052f0| 48 2e 20 4b 6c 61 75 73 | 2c 20 4d 2e 44 2e 0d 0a |H. Klaus|, M.D...|
|00005300| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 32 |$Unique_|ID{YRB02|
|00005310| 34 30 35 7d 0d 0a 24 54 | 69 74 6c 65 7b 45 6e 68 |405}..$T|itle{Enh|
|00005320| 61 6e 63 69 6e 67 20 74 | 68 65 20 4f 75 74 63 6f |ancing t|he Outco|
|00005330| 6d 65 73 20 6f 66 20 4c | 6f 77 2d 42 69 72 74 68 |mes of L|ow-Birth|
|00005340| 2d 57 65 69 67 68 74 2c | 20 50 72 65 6d 61 74 75 |-Weight,| Prematu|
|00005350| 72 65 20 49 6e 66 61 6e | 74 73 3a 20 20 41 0d 0a |re Infan|ts: A..|
|00005360| 4d 75 6c 74 69 73 69 74 | 65 2c 20 52 61 6e 64 6f |Multisit|e, Rando|
|00005370| 6d 69 7a 65 64 20 54 72 | 69 61 6c 7d 0d 0a 24 41 |mized Tr|ial}..$A|
|00005380| 75 74 68 6f 72 7b 0d 0a | 54 68 65 20 49 6e 66 61 |uthor{..|The Infa|
|00005390| 6e 74 20 48 65 61 6c 74 | 68 20 61 6e 64 20 44 65 |nt Healt|h and De|
|000053a0| 76 65 6c 6f 70 6d 65 6e | 74 20 50 72 6f 67 72 61 |velopmen|t Progra|
|000053b0| 6d 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |m}..$Aff|iliation|
|000053c0| 7b 54 68 65 20 49 6e 66 | 61 6e 74 20 48 65 61 6c |{The Inf|ant Heal|
|000053d0| 74 68 20 61 6e 64 20 44 | 65 76 65 6c 6f 70 6d 65 |th and D|evelopme|
|000053e0| 6e 74 20 50 72 6f 67 72 | 61 6d 3b 20 53 74 61 6e |nt Progr|am; Stan|
|000053f0| 66 6f 72 64 3b 20 43 61 | 6c 69 66 7d 0d 0a 24 4a |ford; Ca|lif}..$J|
|00005400| 6f 75 72 6e 61 6c 7b 4a | 41 4d 41 7d 0d 0a 24 56 |ournal{J|AMA}..$V|
|00005410| 6f 6c 75 6d 65 7b 32 36 | 33 7d 0d 0a 24 50 61 67 |olume{26|3}..$Pag|
|00005420| 65 7b 33 30 33 35 2d 33 | 30 34 32 7d 0d 0a 24 44 |e{3035-3|042}..$D|
|00005430| 61 74 65 7b 31 39 39 30 | 7d 0d 0a 24 59 42 56 6f |ate{1990|}..$YBVo|
|00005440| 6c 7b 31 39 39 31 20 59 | 65 61 72 20 42 6f 6f 6b |l{1991 Y|ear Book|
|00005450| 20 6f 66 20 4e 65 6f 6e | 61 74 61 6c 20 61 6e 64 | of Neon|atal and|
|00005460| 20 50 65 72 69 6e 61 74 | 61 6c 20 4d 65 64 69 63 | Perinat|al Medic|
|00005470| 69 6e 65 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 31 |ine}..$C|hapter{1|
|00005480| 38 2d 31 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |8-1}..$Y|BEditor{|
|00005490| 44 72 73 2e 20 4b 6c 61 | 75 73 20 61 6e 64 20 46 |Drs. Kla|us and F|
|000054a0| 61 6e 61 72 6f 66 66 7d | 0d 0a 24 54 61 62 6c 65 |anaroff}|..$Table|
|000054b0| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|000054c0| 7b 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |{}....Co|pyright |
|000054d0| 28 43 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(C) Year| Book Me|
|000054e0| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|000054f0| 2c 20 49 6e 63 2e 20 31 | 39 39 31 0d 0a 0d 0a 31 |, Inc. 1|991....1|
|00005500| 39 39 31 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |991 Year| Book of|
|00005510| 20 4e 65 6f 6e 61 74 61 | 6c 20 61 6e 64 20 50 65 | Neonata|l and Pe|
|00005520| 72 69 6e 61 74 61 6c 20 | 4d 65 64 69 63 69 6e 65 |rinatal |Medicine|
|00005530| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 31 38 20 2d |....Chap|ter 18 -|
|00005540| 2d 20 45 70 69 64 65 6d | 69 6f 6c 6f 67 79 0d 0a |- Epidem|iology..|
|00005550| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00005560| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005570| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005580| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000055a0| 0d 0a 45 6e 68 61 6e 63 | 69 6e 67 20 74 68 65 20 |..Enhanc|ing the |
|000055b0| 4f 75 74 63 6f 6d 65 73 | 20 6f 66 20 4c 6f 77 2d |Outcomes| of Low-|
|000055c0| 42 69 72 74 68 2d 57 65 | 69 67 68 74 2c 20 50 72 |Birth-We|ight, Pr|
|000055d0| 65 6d 61 74 75 72 65 20 | 49 6e 66 61 6e 74 73 3a |emature |Infants:|
|000055e0| 20 20 41 20 4d 75 6c 74 | 69 73 69 74 65 2c 0d 0a | A Mult|isite,..|
|000055f0| 52 61 6e 64 6f 6d 69 7a | 65 64 20 54 72 69 61 6c |Randomiz|ed Trial|
|00005600| 0d 0a 0d 0a 54 68 65 20 | 49 6e 66 61 6e 74 20 48 |....The |Infant H|
|00005610| 65 61 6c 74 68 20 61 6e | 64 20 44 65 76 65 6c 6f |ealth an|d Develo|
|00005620| 70 6d 65 6e 74 20 50 72 | 6f 67 72 61 6d 0d 0a 28 |pment Pr|ogram..(|
|00005630| 54 68 65 20 49 6e 66 61 | 6e 74 20 48 65 61 6c 74 |The Infa|nt Healt|
|00005640| 68 20 61 6e 64 20 44 65 | 76 65 6c 6f 70 6d 65 6e |h and De|velopmen|
|00005650| 74 20 50 72 6f 67 72 61 | 6d 3b 20 53 74 61 6e 66 |t Progra|m; Stanf|
|00005660| 6f 72 64 3b 20 43 61 6c | 69 66 29 0d 0a 4a 41 4d |ord; Cal|if)..JAM|
|00005670| 41 20 32 36 33 3a 33 30 | 33 35 2d 33 30 34 32 2c |A 263:30|35-3042,|
|00005680| 20 31 39 39 30 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1990..-|--------|
|00005690| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000056d0| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|000056e0| 74 0d 0a 0d 0a 20 20 20 | 20 20 54 68 65 20 49 6e |t.... | The In|
|000056f0| 66 61 6e 74 20 48 65 61 | 6c 74 68 20 61 6e 64 20 |fant Hea|lth and |
|00005700| 44 65 76 65 6c 6f 70 6d | 65 6e 74 20 50 72 6f 67 |Developm|ent Prog|
|00005710| 72 61 6d 20 69 73 20 74 | 68 65 20 66 69 72 73 74 |ram is t|he first|
|00005720| 20 6d 75 6c 74 69 73 69 | 74 65 2c 0d 0a 72 61 6e | multisi|te,..ran|
|00005730| 64 6f 6d 69 7a 65 64 20 | 63 6c 69 6e 69 63 61 6c |domized |clinical|
|00005740| 20 74 72 69 61 6c 20 74 | 68 61 74 20 65 76 61 6c | trial t|hat eval|
|00005750| 75 61 74 65 73 20 74 68 | 65 20 65 66 66 69 63 61 |uates th|e effica|
|00005760| 63 79 20 6f 66 20 63 6f | 6d 62 69 6e 69 6e 67 20 |cy of co|mbining |
|00005770| 65 61 72 6c 79 20 63 68 | 69 6c 64 0d 0a 64 65 76 |early ch|ild..dev|
|00005780| 65 6c 6f 70 6d 65 6e 74 | 20 61 6e 64 20 66 61 6d |elopment| and fam|
|00005790| 69 6c 79 20 73 75 70 70 | 6f 72 74 20 73 65 72 76 |ily supp|ort serv|
|000057a0| 69 63 65 73 20 77 69 74 | 68 20 70 65 64 69 61 74 |ices wit|h pediat|
|000057b0| 72 69 63 20 66 6f 6c 6c | 6f 77 2d 75 70 20 69 6e |ric foll|ow-up in|
|000057c0| 20 72 65 64 75 63 69 6e | 67 0d 0a 64 65 76 65 6c | reducin|g..devel|
|000057d0| 6f 70 6d 65 6e 74 61 6c | 2c 20 62 65 68 61 76 69 |opmental|, behavi|
|000057e0| 6f 72 61 6c 2c 20 61 6e | 64 20 6f 74 68 65 72 20 |oral, an|d other |
|000057f0| 68 65 61 6c 74 68 20 70 | 72 6f 62 6c 65 6d 73 20 |health p|roblems |
|00005800| 61 6d 6f 6e 67 20 6c 6f | 77 2d 62 69 72 74 68 2d |among lo|w-birth-|
|00005810| 77 65 69 67 68 74 0d 0a | 28 32 2c 35 30 30 20 67 |weight..|(2,500 g|
|00005820| 20 6f 72 20 6c 65 73 73 | 29 20 70 72 65 6d 61 74 | or less|) premat|
|00005830| 75 72 65 20 28 33 37 20 | 77 65 65 6b 73 20 6f 72 |ure (37 |weeks or|
|00005840| 20 79 6f 75 6e 67 65 72 | 29 20 69 6e 66 61 6e 74 | younger|) infant|
|00005850| 73 2e 20 20 41 20 74 6f | 74 61 6c 20 6f 66 20 39 |s. A to|tal of 9|
|00005860| 38 35 0d 0a 69 6e 66 61 | 6e 74 73 2c 20 73 74 72 |85..infa|nts, str|
|00005870| 61 74 69 66 69 65 64 20 | 62 79 20 73 69 74 65 20 |atified |by site |
|00005880| 61 6e 64 20 77 65 69 67 | 68 74 2c 20 77 65 72 65 |and weig|ht, were|
|00005890| 20 72 61 6e 64 6f 6d 6c | 79 20 61 73 73 69 67 6e | randoml|y assign|
|000058a0| 65 64 20 74 6f 20 72 65 | 63 65 69 76 65 20 61 6e |ed to re|ceive an|
|000058b0| 0d 0a 65 64 75 63 61 74 | 69 6f 6e 61 6c 20 63 75 |..educat|ional cu|
|000058c0| 72 72 69 63 75 6c 75 6d | 20 66 6f 63 75 73 65 64 |rriculum| focused|
|000058d0| 20 6f 6e 20 63 68 69 6c | 64 20 64 65 76 65 6c 6f | on chil|d develo|
|000058e0| 70 6d 65 6e 74 2c 20 66 | 61 6d 69 6c 79 20 73 75 |pment, f|amily su|
|000058f0| 70 70 6f 72 74 2c 20 61 | 6e 64 0d 0a 70 65 64 69 |pport, a|nd..pedi|
|00005900| 61 74 72 69 63 20 66 6f | 6c 6c 6f 77 2d 75 70 2c |atric fo|llow-up,|
|00005910| 20 6f 72 20 70 65 64 69 | 61 74 72 69 63 20 66 6f | or pedi|atric fo|
|00005920| 6c 6c 6f 77 2d 75 70 20 | 6f 6e 6c 79 2e 0d 0a 20 |llow-up |only... |
|00005930| 20 20 20 20 41 74 20 63 | 6f 72 72 65 63 74 65 64 | At c|orrected|
|00005940| 20 61 67 65 20 33 36 20 | 6d 6f 6e 74 68 73 2c 20 | age 36 |months, |
|00005950| 74 68 65 20 69 6e 74 65 | 72 76 65 6e 74 69 6f 6e |the inte|rvention|
|00005960| 20 67 72 6f 75 70 20 68 | 61 64 20 73 69 67 6e 69 | group h|ad signi|
|00005970| 66 69 63 61 6e 74 6c 79 | 0d 0a 68 69 67 68 65 72 |ficantly|..higher|
|00005980| 20 6d 65 61 6e 20 49 51 | 20 73 63 6f 72 65 73 20 | mean IQ| scores |
|00005990| 74 68 61 6e 20 74 68 65 | 20 66 6f 6c 6c 6f 77 2d |than the| follow-|
|000059a0| 75 70 20 67 72 6f 75 70 | 20 28 6d 65 61 6e 20 64 |up group| (mean d|
|000059b0| 69 66 66 65 72 65 6e 63 | 65 20 69 6e 20 74 68 65 |ifferenc|e in the|
|000059c0| 20 68 65 61 76 69 65 72 | 0d 0a 67 72 6f 75 70 20 | heavier|..group |
|000059d0| 77 61 73 20 31 33 2e 32 | 20 61 6e 64 20 69 6e 20 |was 13.2| and in |
|000059e0| 74 68 65 20 6c 69 67 68 | 74 65 72 20 67 72 6f 75 |the ligh|ter grou|
|000059f0| 70 2c 20 36 2e 36 29 2e | 20 20 54 68 65 20 69 6e |p, 6.6).| The in|
|00005a00| 74 65 72 76 65 6e 74 69 | 6f 6e 20 67 72 6f 75 70 |terventi|on group|
|00005a10| 20 68 61 64 0d 0a 73 69 | 67 6e 69 66 69 63 61 6e | had..si|gnifican|
|00005a20| 74 6c 79 20 66 65 77 65 | 72 20 6d 61 74 65 72 6e |tly fewe|r matern|
|00005a30| 61 6c 6c 79 20 72 65 70 | 6f 72 74 65 64 20 62 65 |ally rep|orted be|
|00005a40| 68 61 76 69 6f 72 20 70 | 72 6f 62 6c 65 6d 73 3b |havior p|roblems;|
|00005a50| 20 61 20 73 6d 61 6c 6c | 20 62 75 74 0d 0a 73 74 | a small| but..st|
|00005a60| 61 74 69 73 74 69 63 61 | 6c 6c 79 20 73 69 67 6e |atistica|lly sign|
|00005a70| 69 66 69 63 61 6e 74 20 | 69 6e 63 72 65 61 73 65 |ificant |increase|
|00005a80| 20 69 6e 20 6d 61 74 65 | 72 6e 61 6c 6c 79 20 72 | in mate|rnally r|
|00005a90| 65 70 6f 72 74 65 64 20 | 6d 69 6e 6f 72 20 6d 6f |eported |minor mo|
|00005aa0| 72 62 69 64 69 74 79 20 | 77 61 73 0d 0a 6e 6f 74 |rbidity |was..not|
|00005ab0| 65 64 20 6f 6e 6c 79 20 | 69 6e 20 74 68 65 20 6c |ed only |in the l|
|00005ac0| 69 67 68 74 20 67 72 6f | 75 70 2e 20 20 54 68 65 |ight gro|up. The|
|00005ad0| 72 65 20 77 61 73 20 6e | 6f 20 64 69 66 66 65 72 |re was n|o differ|
|00005ae0| 65 6e 63 65 20 69 6e 20 | 73 65 72 69 6f 75 73 20 |ence in |serious |
|00005af0| 68 65 61 6c 74 68 0d 0a | 70 72 6f 62 6c 65 6d 73 |health..|problems|
|00005b00| 2e 0d 0a 20 20 20 20 20 | 54 68 65 73 65 20 64 61 |... |These da|
|00005b10| 74 61 20 64 65 6d 6f 6e | 73 74 72 61 74 65 20 74 |ta demon|strate t|
|00005b20| 68 65 20 65 66 66 65 63 | 74 69 76 65 6e 65 73 73 |he effec|tiveness|
|00005b30| 20 61 6e 64 20 73 61 66 | 65 74 79 20 6f 66 20 63 | and saf|ety of c|
|00005b40| 6f 6d 70 72 65 68 65 6e | 73 69 76 65 20 61 6e 64 |omprehen|sive and|
|00005b50| 0d 0a 69 6e 74 65 6e 73 | 69 76 65 20 65 61 72 6c |..intens|ive earl|
|00005b60| 79 20 69 6e 74 65 72 76 | 65 6e 74 69 6f 6e 20 69 |y interv|ention i|
|00005b70| 6e 20 72 65 64 75 63 69 | 6e 67 20 74 68 65 20 6e |n reduci|ng the n|
|00005b80| 75 6d 62 65 72 20 6f 66 | 20 6c 6f 77 2d 62 69 72 |umber of| low-bir|
|00005b90| 74 68 2d 77 65 69 67 68 | 74 0d 0a 70 72 65 6d 61 |th-weigh|t..prema|
|00005ba0| 74 75 72 65 20 69 6e 66 | 61 6e 74 73 20 61 74 20 |ture inf|ants at |
|00005bb0| 72 69 73 6b 20 66 6f 72 | 20 6c 61 74 65 72 20 64 |risk for| later d|
|00005bc0| 65 76 65 6c 6f 70 6d 65 | 6e 74 61 6c 20 64 69 73 |evelopme|ntal dis|
|00005bd0| 61 62 69 6c 69 74 79 2e | 20 20 54 68 65 20 6c 6f |ability.| The lo|
|00005be0| 6e 67 2d 74 65 72 6d 0d | 0a 73 69 67 6e 69 66 69 |ng-term.|.signifi|
|00005bf0| 63 61 6e 63 65 20 6f 66 | 20 74 68 65 73 65 20 66 |cance of| these f|
|00005c00| 69 6e 64 69 6e 67 73 20 | 77 69 6c 6c 20 62 65 20 |indings |will be |
|00005c10| 61 64 64 72 65 73 73 65 | 64 20 69 6e 20 74 68 65 |addresse|d in the|
|00005c20| 20 63 6f 6e 74 69 6e 75 | 65 64 20 66 6f 6c 6c 6f | continu|ed follo|
|00005c30| 77 2d 75 70 20 6f 66 0d | 0a 74 68 69 73 20 63 6f |w-up of.|.this co|
|00005c40| 68 6f 72 74 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |hort....|.Post-Co|
|00005c50| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 54 68 |mment...|. Th|
|00005c60| 69 73 20 69 73 20 61 20 | 77 6f 6e 64 65 72 66 75 |is is a |wonderfu|
|00005c70| 6c 20 65 78 61 6d 70 6c | 65 20 6f 66 20 61 20 6d |l exampl|e of a m|
|00005c80| 75 6c 74 69 73 69 74 65 | 20 72 61 6e 64 6f 6d 69 |ultisite| randomi|
|00005c90| 7a 65 64 20 74 72 69 61 | 6c 2e 20 20 46 72 6f 6d |zed tria|l. From|
|00005ca0| 20 74 68 65 0d 0a 69 6e | 69 74 69 61 6c 20 63 6f | the..in|itial co|
|00005cb0| 6d 70 65 74 69 74 69 6f | 6e 20 66 6f 72 20 74 68 |mpetitio|n for th|
|00005cc0| 65 20 70 61 72 74 69 63 | 69 70 61 74 69 6e 67 20 |e partic|ipating |
|00005cd0| 63 65 6e 74 65 72 73 2c | 20 74 68 72 6f 75 67 68 |centers,| through|
|00005ce0| 20 74 68 65 20 73 74 75 | 64 79 20 64 65 73 69 67 | the stu|dy desig|
|00005cf0| 6e 2c 0d 0a 70 61 74 69 | 65 6e 74 20 65 6e 72 6f |n,..pati|ent enro|
|00005d00| 6c 6c 6d 65 6e 74 2c 20 | 66 6f 6c 6c 6f 77 2d 75 |llment, |follow-u|
|00005d10| 70 2c 20 61 6e 64 20 64 | 61 74 61 20 6d 61 6e 61 |p, and d|ata mana|
|00005d20| 67 65 6d 65 6e 74 2c 20 | 74 68 69 73 20 74 72 69 |gement, |this tri|
|00005d30| 61 6c 20 63 61 6e 20 6f | 6e 6c 79 20 62 65 0d 0a |al can o|nly be..|
|00005d40| 6c 61 62 65 6c 65 64 20 | 66 69 72 73 74 20 63 6c |labeled |first cl|
|00005d50| 61 73 73 2e 20 20 54 68 | 65 20 67 6f 61 6c 20 6f |ass. Th|e goal o|
|00005d60| 66 20 65 6e 68 61 6e 63 | 69 6e 67 20 74 68 65 20 |f enhanc|ing the |
|00005d70| 6f 75 74 63 6f 6d 65 73 | 20 6f 66 20 6c 6f 77 2d |outcomes| of low-|
|00005d80| 62 69 72 74 68 2d 77 65 | 69 67 68 74 0d 0a 70 72 |birth-we|ight..pr|
|00005d90| 65 6d 61 74 75 72 65 20 | 69 6e 66 61 6e 74 73 20 |emature |infants |
|00005da0| 69 73 20 6d 61 67 6e 61 | 6e 69 6d 6f 75 73 20 61 |is magna|nimous a|
|00005db0| 6e 64 20 74 69 6d 65 6c | 79 2e 20 20 54 68 65 20 |nd timel|y. The |
|00005dc0| 66 61 69 72 79 20 74 61 | 6c 65 20 77 6f 75 6c 64 |fairy ta|le would|
|00005dd0| 20 62 65 20 63 6f 6d 70 | 6c 65 74 65 0d 0a 69 66 | be comp|lete..if|
|00005de0| 20 74 68 65 20 68 79 70 | 6f 74 68 65 73 69 73 20 | the hyp|othesis |
|00005df0| 77 65 72 65 20 70 72 6f | 76 65 6e 20 61 6e 64 20 |were pro|ven and |
|00005e00| 69 6e 74 65 72 76 65 6e | 74 69 6f 6e 20 65 6e 68 |interven|tion enh|
|00005e10| 61 6e 63 65 64 20 74 68 | 65 20 6f 75 74 63 6f 6d |anced th|e outcom|
|00005e20| 65 20 6f 66 0d 0a 6c 6f | 77 2d 62 69 72 74 68 2d |e of..lo|w-birth-|
|00005e30| 77 65 69 67 68 74 20 69 | 6e 66 61 6e 74 73 2e 20 |weight i|nfants. |
|00005e40| 20 54 68 65 72 65 20 69 | 73 20 64 6f 63 75 6d 65 | There i|s docume|
|00005e50| 6e 74 61 74 69 6f 6e 20 | 6f 66 20 69 6d 70 72 6f |ntation |of impro|
|00005e60| 76 65 64 20 6f 75 74 63 | 6f 6d 65 20 61 6e 64 0d |ved outc|ome and.|
|00005e70| 0a 69 6e 74 65 6c 6c 65 | 63 74 20 69 6e 20 74 68 |.intelle|ct in th|
|00005e80| 65 20 67 72 6f 75 70 20 | 72 65 63 65 69 76 69 6e |e group |receivin|
|00005e90| 67 20 74 68 65 20 69 6e | 74 65 72 76 65 6e 74 69 |g the in|terventi|
|00005ea0| 6f 6e 2e 20 20 55 6e 66 | 6f 72 74 75 6e 61 74 65 |on. Unf|ortunate|
|00005eb0| 6c 79 2c 20 69 6e 20 74 | 68 65 0d 0a 6c 6f 77 65 |ly, in t|he..lowe|
|00005ec0| 72 20 62 69 72 74 68 20 | 77 65 69 67 68 74 20 63 |r birth |weight c|
|00005ed0| 61 74 65 67 6f 72 69 65 | 73 2c 20 61 6e 64 20 74 |ategorie|s, and t|
|00005ee0| 68 65 73 65 20 77 65 72 | 65 20 62 79 20 6e 6f 20 |hese wer|e by no |
|00005ef0| 6d 65 61 6e 73 20 65 78 | 74 72 65 6d 65 6c 79 0d |means ex|tremely.|
|00005f00| 0a 6c 6f 77 2d 62 69 72 | 74 68 2d 77 65 69 67 68 |.low-bir|th-weigh|
|00005f10| 74 20 69 6e 66 61 6e 74 | 73 2c 20 74 68 65 20 64 |t infant|s, the d|
|00005f20| 69 66 66 65 72 65 6e 63 | 65 20 69 73 20 6f 6e 6c |ifferenc|e is onl|
|00005f30| 79 20 36 2e 36 20 70 6f | 69 6e 74 73 20 6f 6e 20 |y 6.6 po|ints on |
|00005f40| 74 68 65 20 53 74 61 6e | 66 6f 72 64 0d 0a 42 69 |the Stan|ford..Bi|
|00005f50| 6e 65 74 2e 20 20 48 6f | 77 20 77 69 6c 6c 20 74 |net. Ho|w will t|
|00005f60| 68 69 73 20 74 72 61 6e | 73 6c 61 74 65 20 77 69 |his tran|slate wi|
|00005f70| 74 68 20 72 65 67 61 72 | 64 20 74 6f 20 73 63 68 |th regar|d to sch|
|00005f80| 6f 6f 6c 20 70 65 72 66 | 6f 72 6d 61 6e 63 65 3f |ool perf|ormance?|
|00005f90| 0d 0a 20 20 20 20 20 4e | 6f 6e 65 74 68 65 6c 65 |.. N|onethele|
|00005fa0| 73 73 2c 20 74 68 65 72 | 65 20 69 73 20 61 20 64 |ss, ther|e is a d|
|00005fb0| 69 66 66 65 72 65 6e 63 | 65 2c 20 61 6e 64 20 6f |ifferenc|e, and o|
|00005fc0| 6e 6c 79 20 63 6f 6e 74 | 69 6e 75 65 64 20 6f 62 |nly cont|inued ob|
|00005fd0| 73 65 72 76 61 74 69 6f | 6e 20 6f 66 0d 0a 74 68 |servatio|n of..th|
|00005fe0| 69 73 20 63 6f 68 6f 72 | 74 20 77 69 6c 6c 20 64 |is cohor|t will d|
|00005ff0| 65 6d 6f 6e 73 74 72 61 | 74 65 20 74 68 65 20 66 |emonstra|te the f|
|00006000| 75 6c 6c 20 69 6d 70 61 | 63 74 20 6f 66 20 74 68 |ull impa|ct of th|
|00006010| 65 20 69 6e 74 65 72 76 | 65 6e 74 69 6f 6e 2e 20 |e interv|ention. |
|00006020| 20 49 6e 20 74 68 65 20 | 6d 65 61 6e 0d 0a 74 69 | In the |mean..ti|
|00006030| 6d 65 2c 20 72 65 73 6f | 75 72 63 65 73 20 6e 65 |me, reso|urces ne|
|00006040| 65 64 20 74 6f 20 62 65 | 20 6d 61 72 73 68 61 6c |ed to be| marshal|
|00006050| 6c 65 64 20 74 6f 20 70 | 72 6f 76 69 64 65 20 73 |led to p|rovide s|
|00006060| 74 69 6d 75 6c 61 74 69 | 6e 67 20 70 72 6f 67 72 |timulati|ng progr|
|00006070| 61 6d 73 20 66 6f 72 20 | 6d 61 6e 79 0d 0a 6d 6f |ams for |many..mo|
|00006080| 72 65 20 61 74 2d 72 69 | 73 6b 20 67 72 61 64 75 |re at-ri|sk gradu|
|00006090| 61 74 65 73 20 66 72 6f | 6d 20 74 68 65 20 69 6e |ates fro|m the in|
|000060a0| 74 65 6e 73 69 76 65 20 | 63 61 72 65 20 75 6e 69 |tensive |care uni|
|000060b0| 74 2c 20 6e 6f 74 61 62 | 6c 79 20 74 68 6f 73 65 |t, notab|ly those|
|000060c0| 20 66 72 6f 6d 20 6c 6f | 77 65 72 0d 0a 73 6f 63 | from lo|wer..soc|
|000060d0| 69 6f 65 63 6f 6e 6f 6d | 69 63 20 73 74 72 61 74 |ioeconom|ic strat|
|000060e0| 61 2e 0d 0a 20 20 20 20 | 20 22 53 75 63 63 65 73 |a... | "Succes|
|000060f0| 73 20 77 69 6c 6c 20 72 | 65 71 75 69 72 65 20 61 |s will r|equire a|
|00006100| 6c 6c 20 6f 75 72 20 63 | 72 65 61 74 69 76 69 74 |ll our c|reativit|
|00006110| 79 2c 20 63 6f 6d 6d 69 | 74 6d 65 6e 74 20 61 6e |y, commi|tment an|
|00006120| 64 20 65 6e 65 72 67 79 | 2e 22 2d 2d 50 65 74 65 |d energy|."--Pete|
|00006130| 72 0d 0a 4c 65 77 69 73 | 0d 0a 20 20 20 20 20 41 |r..Lewis|.. A|
|00006140| 2e 41 2e 20 46 61 6e 61 | 72 6f 66 66 2c 20 4d 2e |.A. Fana|roff, M.|
|00006150| 42 2e 42 2e 43 68 2e 0d | 0a 24 55 6e 69 71 75 65 |B.B.Ch..|.$Unique|
|00006160| 5f 49 44 7b 59 52 42 30 | 32 34 30 36 7d 0d 0a 24 |_ID{YRB0|2406}..$|
|00006170| 54 69 74 6c 65 7b 54 68 | 65 20 52 65 6c 61 74 69 |Title{Th|e Relati|
|00006180| 6f 6e 20 6f 66 20 4f 62 | 73 74 65 74 72 69 63 61 |on of Ob|stetrica|
|00006190| 6c 20 56 6f 6c 75 6d 65 | 20 61 6e 64 20 4e 75 72 |l Volume| and Nur|
|000061a0| 73 65 72 79 20 4c 65 76 | 65 6c 20 74 6f 20 50 65 |sery Lev|el to Pe|
|000061b0| 72 69 6e 61 74 61 6c 0d | 0a 4d 6f 72 74 61 6c 69 |rinatal.|.Mortali|
|000061c0| 74 79 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 0d 0a 4d |ty}..$Au|thor{..M|
|000061d0| 61 79 66 69 65 6c 64 2c | 20 4a 41 0d 0a 52 6f 73 |ayfield,| JA..Ros|
|000061e0| 65 6e 62 6c 61 74 74 2c | 20 52 41 0d 0a 42 61 6c |enblatt,| RA..Bal|
|000061f0| 64 77 69 6e 2c 20 4c 2d | 4d 0d 0a 43 68 75 2c 20 |dwin, L-|M..Chu, |
|00006200| 4a 0d 0a 4c 6f 67 65 72 | 66 6f 2c 20 4a 50 7d 0d |J..Loger|fo, JP}.|
|00006210| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 55 6e |.$Affili|ation{Un|
|00006220| 69 76 20 6f 66 20 57 61 | 73 68 69 6e 67 74 6f 6e |iv of Wa|shington|
|00006230| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 41 6d 20 4a |}..$Jour|nal{Am J|
|00006240| 20 50 75 62 6c 69 63 20 | 48 65 61 6c 74 68 7d 0d | Public |Health}.|
|00006250| 0a 24 56 6f 6c 75 6d 65 | 7b 38 30 7d 0d 0a 24 50 |.$Volume|{80}..$P|
|00006260| 61 67 65 7b 38 31 39 2d | 38 32 33 7d 0d 0a 24 44 |age{819-|823}..$D|
|00006270| 61 74 65 7b 31 39 39 30 | 7d 0d 0a 24 59 42 56 6f |ate{1990|}..$YBVo|
|00006280| 6c 7b 31 39 39 31 20 59 | 65 61 72 20 42 6f 6f 6b |l{1991 Y|ear Book|
|00006290| 20 6f 66 20 4e 65 6f 6e | 61 74 61 6c 20 61 6e 64 | of Neon|atal and|
|000062a0| 20 50 65 72 69 6e 61 74 | 61 6c 20 4d 65 64 69 63 | Perinat|al Medic|
|000062b0| 69 6e 65 7d 0d 0a 24 43 | 68 61 70 74 65 72 7b 31 |ine}..$C|hapter{1|
|000062c0| 38 2d 32 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |8-2}..$Y|BEditor{|
|000062d0| 44 72 73 2e 20 4b 6c 61 | 75 73 20 61 6e 64 20 46 |Drs. Kla|us and F|
|000062e0| 61 6e 61 72 6f 66 66 7d | 0d 0a 24 54 61 62 6c 65 |anaroff}|..$Table|
|000062f0| 7b 54 61 62 6c 65 20 4f | 6d 69 74 74 65 64 7d 0d |{Table O|mitted}.|
|00006300| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 4d 2e |.$Commen|tator{M.|
|00006310| 48 2e 20 4b 6c 61 75 73 | 2c 20 4d 2e 44 2e 7d 0d |H. Klaus|, M.D.}.|
|00006320| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 43 29 |...Copyr|ight (C)|
|00006330| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
|00006340| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00006350| 6e 63 2e 20 31 39 39 31 | 0d 0a 0d 0a 31 39 39 31 |nc. 1991|....1991|
|00006360| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4e 65 | Year Bo|ok of Ne|
|00006370| 6f 6e 61 74 61 6c 20 61 | 6e 64 20 50 65 72 69 6e |onatal a|nd Perin|
|00006380| 61 74 61 6c 20 4d 65 64 | 69 63 69 6e 65 0d 0a 0d |atal Med|icine...|
|00006390| 0a 43 68 61 70 74 65 72 | 20 31 38 20 2d 2d 20 45 |.Chapter| 18 -- E|
|000063a0| 70 69 64 65 6d 69 6f 6c | 6f 67 79 0d 0a 0d 0a 2d |pidemiol|ogy....-|
|000063b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000063c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000063d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000063e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000063f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 54 |--------|-----..T|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.
